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General NPI Number Information
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NPI Number | 1659701894
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 6601 BLANCO RD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6103
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Country | US
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Telephone | 210-541-0018
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Fax | 210-541-0024
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Provider Business Mailing Address
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Address Line | 6601 BLANCO RD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6103
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Country | US
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Telephone | 210-541-0018
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Fax | 210-541-0024
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Authorized Official
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Title or Position | BILLER
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Name | MRS. MARTHA CANTU
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Credential |
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Telephone | 210-541-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N1488
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License Number State | TX
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