Healthcare Provider Details

I. General information

NPI: 1528202744
Provider Name (Legal Business Name): JIMMY Z GATICA CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR ROOM 638E
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

7703 FLOYD CURL DR ROOM 638E
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-5346
  • Fax:
Mailing address:
  • Phone: 210-567-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number01263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: