Healthcare Provider Details

I. General information

NPI: 1033381447
Provider Name (Legal Business Name): NORTHEAST INTERNAL MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12602 TOEPPERWEIN RD SUITE #100
SAN ANTONIO TX
78233-3269
US

IV. Provider business mailing address

12602 TOEPPERWEIN RD SUITE #100
SAN ANTONIO TX
78233-3269
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9669
  • Fax: 210-650-0750
Mailing address:
  • Phone: 210-650-9669
  • Fax: 210-650-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBERTA S. CLOUD
Title or Position: VICE PRESIDENT
Credential:
Phone: 210-575-8505