Basic Information
| Provider Information | |||||||||
| NPI: | 1073598520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REBOLLAR | ||||||||
| FirstName: | CARIDAD | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7142 SAN PEDRO AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106615622 | ||||||||
| FaxNumber: | 2103954012 | ||||||||
| Practice Location | |||||||||
| Address1: | 2902 GOLIAD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782233958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103374911 | ||||||||
| FaxNumber: | 2103377749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K3419 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | K3419 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1182636-05 | 05 | TX | MEDICAID | 118263603 | 05 | TX | MEDICAID | 110207848 | 01 | TX | MEDICARE RAILROAD | OTHER |