MEDICARE: MARTIN BASOBAS ORDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134920226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BASOBAS ORDEN

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR STE 1713
Second Line	:	MAGGIE MEDRANO / 210-575-7002
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3735
Country	:	US
Telephone Number	:	210-575-7002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 1713
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3735
Country	:	US
Telephone Number	:	210-575-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/28/2025

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Directions to “ MARTIN BASOBAS ORDEN ” Practice Location

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