Healthcare Provider Details

I. General information

NPI: 1629291851
Provider Name (Legal Business Name): NORTH BLANCO FAMILY PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15102 HUEBNER RD
SAN ANTONIO TX
78231-1739
US

IV. Provider business mailing address

15102 HUEBNER RD
SAN ANTONIO TX
78231-1739
US

V. Phone/Fax

Practice location:
  • Phone: 210-493-3993
  • Fax: 210-493-1521
Mailing address:
  • Phone: 210-493-3993
  • Fax: 210-493-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN SHIMOTSU
Title or Position: OWNER
Credential: M.D.
Phone: 210-493-3993