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General NPI Number Information
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NPI Number | 1356951735
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS DIABETES & WELLNESS INSTITUTE
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 5441 BABCOCK RD STE 203
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City | SAN ANTONIO
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State | TX
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Zip | 78240-3993
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Country | US
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Telephone | 210-701-8890
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Fax | 210-783-8840
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Provider Business Mailing Address
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Address Line | 8428 BANDERA RD STE 2
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City | SAN ANTONIO
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State | TX
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Zip | 78250-2514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARRA GREEN-CALDERON
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Credential | MD
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Telephone | 832-560-0254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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