Healthcare Provider Details

I. General information

NPI: 1316964745
Provider Name (Legal Business Name): CAMILO ALBERTO GONIMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 FLOYD CURL DR SUITE 900
SAN ANTONIO TX
78229-3906
US

IV. Provider business mailing address

1210 ARION PKWY
SAN ANTONIO TX
78216-2880
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-1000
  • Fax: 210-615-1236
Mailing address:
  • Phone: 210-349-9300
  • Fax: 210-366-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL4398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: