=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932388972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCENT A CALDAROLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 10/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4499 MEDICAL DR SUITE 250
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-3565
-----------------------------------------------------
Fax | 210-614-3563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4499 MEDICAL DR SUITE 250
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-3565
-----------------------------------------------------
Fax | 210-614-3563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYCISIAN
-----------------------------------------------------
Name | DR. VINCENT A CALDAROLA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-614-3565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G1345
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------