Healthcare Provider Details

I. General information

NPI: 1174528319
Provider Name (Legal Business Name): MARY GOMEZ CURLL RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S PRESA ST
SAN ANTONIO TX
78210-1359
US

IV. Provider business mailing address

1730 FAWN GATE
SAN ANTONIO TX
78248-1325
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-9340
  • Fax: 210-228-9342
Mailing address:
  • Phone: 210-492-7278
  • Fax: 210-479-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number500273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: