Healthcare Provider Details

I. General information

NPI: 1821286600
Provider Name (Legal Business Name): VALLEY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9102 FLOYD CURL DR
SAN ANTONIO TX
78240-1553
US

IV. Provider business mailing address

9102 FLOYD CURL DR
SAN ANTONIO TX
78240-1553
US

V. Phone/Fax

Practice location:
  • Phone: 210-308-5933
  • Fax: 210-809-6267
Mailing address:
  • Phone: 210-308-5933
  • Fax: 210-809-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: GERARDO VAZQUEZ
Title or Position: DOCTOR
Credential: MD
Phone: 210-308-5933