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General NPI Number Information
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NPI Number | 1538411962
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Entity Type | Organization
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Legal Business Name | EYELID INSTITUTE, P.A.
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 307 COLLEGE BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4518
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Country | US
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Telephone | 210-828-8892
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6312
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City | SAN ANTONIO
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State | TX
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Zip | 78209-0312
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Country | US
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Telephone | 210-828-8892
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE L. RIVERA
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Credential | M.D.
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Telephone | 210-828-8892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G0814
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License Number State | TX
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