Healthcare Provider Details

I. General information

NPI: 1396973640
Provider Name (Legal Business Name): SUJATHA GERINENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 WALKERS WAY STE 101
SAN ANTONIO TX
78216-7752
US

IV. Provider business mailing address

2313 LOCKHILL SELMA RD STE 102
SAN ANTONIO TX
78230-3007
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7933
  • Fax: 731-201-5068
Mailing address:
  • Phone: 210-245-7933
  • Fax: 731-201-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberP4954
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: