Healthcare Provider Details

I. General information

NPI: 1285109272
Provider Name (Legal Business Name): FULL CIRCLE MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14329 SAN PEDRO AVE STE C
SAN ANTONIO TX
78232-4389
US

IV. Provider business mailing address

14329 SAN PEDRO AVE STE C
SAN ANTONIO TX
78232-4389
US

V. Phone/Fax

Practice location:
  • Phone: 210-494-2744
  • Fax: 210-494-2866
Mailing address:
  • Phone: 210-494-2744
  • Fax: 210-494-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RUBEN GALVAN JR.
Title or Position: OWNER
Credential: FNP
Phone: 210-494-2744