Healthcare Provider Details

I. General information

NPI: 1609425115
Provider Name (Legal Business Name): GOOD HEALTH CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PLEASANTON RD
SAN ANTONIO TX
78214-1335
US

IV. Provider business mailing address

505 PLEASANTON RD
SAN ANTONIO TX
78214-1335
US

V. Phone/Fax

Practice location:
  • Phone: 210-932-2565
  • Fax: 210-932-2566
Mailing address:
  • Phone: 210-422-2336
  • Fax: 210-932-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA B TREVINO
Title or Position: PHYSICIAN ASSISTANT/ MANAGER
Credential: PA-C
Phone: 210-422-2336