MEDICARE: CRISTO REY CLINIC, PA

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

General Provider Information

NPI Number	:	1316067903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRISTO REY CLINIC, PA

Provider Business Mailing Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-229-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-229-9100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOEL PENA JR.
Credential	:	MD
Telephone Number	:	210-229-9100

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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