Healthcare Provider Details

I. General information

NPI: 1972734234
Provider Name (Legal Business Name): FABIAN VICENTE RODAS OCHOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CAMDEN ST STE 108
SAN ANTONIO TX
78215
US

IV. Provider business mailing address

607 CAMDEN ST STE 108
SAN ANTONIO TX
78215-2100
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax: 210-237-4807
Mailing address:
  • Phone: 210-253-3426
  • Fax: 210-237-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: