Healthcare Provider Details

I. General information

NPI: 1174140842
Provider Name (Legal Business Name): KERMITH SAUL VEGA CARTAGENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 E SOUTHCROSS BLVD STE 205
SAN ANTONIO TX
78222-3750
US

IV. Provider business mailing address

4243 E SOUTHCROSS BLVD STE 205
SAN ANTONIO TX
78222-3750
US

V. Phone/Fax

Practice location:
  • Phone: 210-304-3500
  • Fax: 210-337-2909
Mailing address:
  • Phone: 210-304-3500
  • Fax: 210-337-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU0868
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: