MEDICARE: CLINICAS DE MEDICINA, P.A.

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	207R00000X	Internal Medicine Physician	L7592	TX

General Provider Information

NPI Number	:	1225400286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAS DE MEDICINA, P.A.

Provider Business Mailing Address
First Line	:	1302 S GENERAL MCMULLEN DR
Second Line	:	STE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-904-8770
Fax Number	:	210-370-3745

Provider Business Practice Location Address
First Line	:	1302 S GENERAL MCMULLEN DR
Second Line	:	SUITE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-904-8770
Fax Number	:	210-370-3745

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESUS ALFREDO VIRLAR
Credential	:	M.D.
Telephone Number	:	210-376-0981

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	05/10/2016

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