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General NPI Number Information
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NPI Number | 1285077081
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Entity Type | Organization
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Legal Business Name | SOUTHERN TEXAS HEART AND VASCULAR CLINIC, PLLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 12501 JUDSON RD STE 202
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City | LIVE OAK
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State | TX
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Zip | 78233-4117
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Country | US
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Telephone | 210-599-4086
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Fax | 210-655-1401
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Provider Business Mailing Address
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Address Line | 12709 TOEPPERWEIN RD STE 205
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City | LIVE OAK
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State | TX
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Zip | 78233-3260
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Country | US
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Telephone | 210-653-0887
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Fax | 210-653-0615
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JUAN DIEGO MARTINEZ
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Credential | M.D.
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Telephone | 210-653-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | P0091
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License Number State | TX
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