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General NPI Number Information
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NPI Number | 1063091601
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Entity Type | Individual
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Provider Name | JEWEL MARIE DATRI MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 8210 CALLAGHAN RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-4775
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Country | US
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Telephone | 210-233-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 25506 SINGING RAIN
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City | SAN ANTONIO
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State | TX
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Zip | 78260-6269
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Country | US
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Telephone | 504-292-2697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | V4359
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License Number State | TX
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