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NPI Code Detail

MEDICARE: DR. ADRIENNE BRENT GAMIS ESTABILLO MD

MEDICARE: DR. ADRIENNE BRENT GAMIS ESTABILLO MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry PhysicianU9906TX

General Provider Information

NPI Number : 1588283667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADRIENNE BRENT GAMIS ESTABILLO MD
Provider Business Mailing Address
First Line : 5718 QUAIL CROWN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-3134
Country : US
Telephone Number : 956-472-0935
Fax Number :
Provider Business Practice Location Address
First Line : 4502 MEDICAL DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4492
Country : US
Telephone Number : 210-358-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2020
Last Update Date : 04/25/2025

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