MEDICARE: SAN ANTONIO INSTITUTE OF DIABETES, THYROID & ENDOCRINE DISORDERS, INC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265160196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO INSTITUTE OF DIABETES, THYROID & ENDOCRINE DISORDERS, INC

Provider Business Mailing Address
First Line	:	4025 E SOUTHCROSS BLVD STE 7
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3640
Country	:	US
Telephone Number	:	210-267-9229
Fax Number	:	210-267-8005

Provider Business Practice Location Address
First Line	:	4025 E SOUTHCROSS BLVD STE 7
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3640
Country	:	US
Telephone Number	:	210-267-9229
Fax Number	:	210-267-8005

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MARLISE NEGRETTE
Credential	:
Telephone Number	:	909-793-5511

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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