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General NPI Number Information
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NPI Number | 1164658332
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 6601 BLANCO RD SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6102
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Country | US
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Telephone | 210-541-0018
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Fax | 210-541-0024
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Provider Business Mailing Address
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Address Line | 6601 BLANCO RD SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6102
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Country | US
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Telephone | 210-541-0018
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Fax | 210-541-0024
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. JUAN PENA VELAZQUEZ
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Credential | M.D.
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Telephone | 210-541-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N1488
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License Number State | TX
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