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General NPI Number Information
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NPI Number | 1457273203
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Entity Type | Organization
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Legal Business Name | CLINICA FAMILIAR BANDERA LLC
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Dates
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Enumeration Date | 07/25/2026
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Last Update Date | 07/25/2026
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Provider Practice Location Address
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Address Line | 8103 BANDERA RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78250-5185
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Country | US
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Telephone | 210-500-2914
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Fax |
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Provider Business Mailing Address
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Address Line | 12134 STONEY CV
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City | SAN ANTONIO
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State | TX
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Zip | 78247-4918
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Country | US
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Telephone | 832-705-2204
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Fax |
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Authorized Official
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Title or Position | CEO / MANAGING MEMBER
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Name | ANDY RAUL MANZANO MATOS
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Credential |
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Telephone | 832-705-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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