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General NPI Number Information
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NPI Number | 1336612274
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Entity Type | Organization
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Legal Business Name | BROOKS CITY BASE CARDIOVASCULAR
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 4025 E SOUTHCROSS BLVD STE 15
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City | SAN ANTONIO
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State | TX
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Zip | 78222-3641
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Country | US
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Telephone | 832-439-7889
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 E SOUTHCROSS BLVD STE 15
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City | SAN ANTONIO
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State | TX
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Zip | 78222-3641
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Country | US
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Telephone | 832-439-7889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL TODD FAZ
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Credential | MD
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Telephone | 832-439-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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