Healthcare Provider Details

I. General information

NPI: 1679948392
Provider Name (Legal Business Name): BEXAR COUNTY BOARD OF TRUSTEES FOR MENTAL HEALTH MENTAL RETARDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 PARK TEN BLVD SUITE 200-S
SAN ANTONIO TX
78213-4211
US

IV. Provider business mailing address

6800 PARK TEN BLVD SUITE 200-S
SAN ANTONIO TX
78213-4211
US

V. Phone/Fax

Practice location:
  • Phone: 210-261-1000
  • Fax: 210-261-1821
Mailing address:
  • Phone: 210-261-1000
  • Fax: 210-261-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENE GARCIA
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 210-261-1072