Healthcare Provider Details

I. General information

NPI: 1720666126
Provider Name (Legal Business Name): NANCY CHAVEZ-COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 WEST AVE
SAN ANTONIO TX
78201-2243
US

IV. Provider business mailing address

2925 WEST AVE
SAN ANTONIO TX
78201-2243
US

V. Phone/Fax

Practice location:
  • Phone: 210-761-3393
  • Fax: 210-761-3397
Mailing address:
  • Phone: 210-761-3393
  • Fax: 210-761-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1934000000X
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1029156
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: