Basic Information
| Provider Information | |||||||||
| NPI: | 1215680467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE TELEHEALTH SOLUTIONS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 ENCINO BREEZE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782593567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102254810 | ||||||||
| FaxNumber: | 2106863831 | ||||||||
| Practice Location | |||||||||
| Address1: | 2111 ENCINO BREEZE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782593567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102254810 | ||||||||
| FaxNumber: | 2106863831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2022 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | VALDES | ||||||||
| AuthorizedOfficialFirstName: | PAVEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2102254810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.