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General NPI Number Information
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NPI Number | 1629105408
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY NORTHWEST SAN ANTONIO, P.A.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2829 BABCOCK RD SUITE 600
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City | SAN ANTONIO
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State | TX
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Zip | 78229-6028
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Country | US
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Telephone | 210-615-1515
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Fax | 210-615-1550
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Provider Business Mailing Address
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Address Line | 2829 BABCOCK RD SUITE 600
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City | SAN ANTONIO
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State | TX
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Zip | 78229-6028
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Country | US
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Telephone | 210-615-1515
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Fax | 210-615-1550
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A JACOB
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Credential | M.D.
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Telephone | 210-615-1515
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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 | F4114
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License Number State | TX
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