| NPI | 1730584608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA JENELLE ORTIZ Chief Administrator 210-910-4186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L7688) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX 03210) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 748540) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |