Healthcare Provider Details

I. General information

NPI: 1508144320
Provider Name (Legal Business Name): GABRIELA MONTEJANO - DE LA CRUZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S GENERAL MCMULLEN DR
SAN ANTONIO TX
78237-2005
US

IV. Provider business mailing address

630 S GENERAL MCMULLEN DR
SAN ANTONIO TX
78237-2005
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-8500
  • Fax: 210-644-8525
Mailing address:
  • Phone: 210-644-8500
  • Fax: 210-644-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number775654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: