Basic Information
| Provider Information | |||||||||
| NPI: | 1366581589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOCRINOLOGY NUCLEAR MEDICINE ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 MCCULLOUGH AVE | ||||||||
| Address2: | SUITE 374 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102235483 | ||||||||
| FaxNumber: | 2102235492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 MCCULLOUGH AVE | ||||||||
| Address2: | SUITE 374 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102235483 | ||||||||
| FaxNumber: | 2102235492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | YOLANDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2102235483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 083522501 | 05 | TX | MEDICAID |