Healthcare Provider Details

I. General information

NPI: 1023206513
Provider Name (Legal Business Name): CENTER FOR INTERNAL MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8265 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3357
US

IV. Provider business mailing address

PO BOX 291096
SAN ANTONIO TX
78229-1696
US

V. Phone/Fax

Practice location:
  • Phone: 210-200-8798
  • Fax: 877-904-3712
Mailing address:
  • Phone: 210-200-8798
  • Fax: 877-904-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberL7397
License Number StateTX

VIII. Authorized Official

Name: JUAN CARLOS GONZALEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-200-8798