Basic Information
Provider Information
NPI: 1154772531
EntityType: 2
ReplacementNPI:  
OrganizationName: CIELO VISTA MEDICAL PRACTICE P.A.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 29408
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782290408
CountryCode: US
TelephoneNumber: 2106151626
FaxNumber: 2106151636
Practice Location
Address1: 21604 CIELO RIDGE DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782569604
CountryCode: US
TelephoneNumber: 2106831329
FaxNumber: 2106151636
Other Information
ProviderEnumerationDate: 06/27/2016
LastUpdateDate: 03/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FLORES
AuthorizedOfficialFirstName: SERINA
AuthorizedOfficialMiddleName: MARIE
AuthorizedOfficialTitleorPosition: OWNER/PRESIDENT
AuthorizedOfficialTelephone: 2106831329
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XL8057TXY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
L805701TXLICENSEOTHER


Home