Healthcare Provider Details

I. General information

NPI: 1356325922
Provider Name (Legal Business Name): SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7142 SAN PEDRO AVE STE 120
SAN ANTONIO TX
78216-6256
US

IV. Provider business mailing address

7142 SAN PEDRO AVE STE 120
SAN ANTONIO TX
78216-6256
US

V. Phone/Fax

Practice location:
  • Phone: 210-661-5622
  • Fax: 210-798-6811
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-798-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: VERONICA AGUIRRE
Title or Position: ASSISTANCE ADMINISTRATOR
Credential:
Phone: 210-661-5622