Healthcare Provider Details

I. General information

NPI: 1417931031
Provider Name (Legal Business Name): ALFREDO J. FIALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALTIMORE
SAN ANTONIO TX
78215-1919
US

IV. Provider business mailing address

7142 SAN PEDRO AVE SUITE 120
SAN ANTONIO TX
78216-6256
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0743
  • Fax: 210-228-9749
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-395-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH6815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: