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General NPI Number Information
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NPI Number | 1669801254
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Entity Type | Organization
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Legal Business Name | VALLEY CLINIC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 6430 BANDERA RD SUITE 98
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City | SAN ANTONIO
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State | TX
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Zip | 78238-1500
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Country | US
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Telephone | 210-520-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 6430 BANDERA RD SUITE 98
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City | SAN ANTONIO
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State | TX
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Zip | 78238-1500
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Country | US
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Telephone | 210-520-4461
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERADO VAZQUEZ
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Credential | M.D.
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Telephone | 210-520-4461
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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 | G6036
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License Number State | TX
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