Organization
KIDNEY AND BLOOD PRESSURE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA J MEDOLA (SUPERVISOR)
(210) 692-1515
Entity
Organization
Contact information
Practice address
3939 MEDICAL DR, STE 110, SAN ANTONIO, TX 78229-2292
(210) 692-1515
(210) 692-0187
Mailing address
3939 MEDICAL DR, STE 110, SAN ANTONIO, TX 78229-2292
(210) 692-1515
(210) 692-0187
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
F1406
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00GT38
BC/BS
TX
05
—
0828279-01
—
TX
Enumeration date
06/08/2005
Last updated
03/26/2008
Update your record
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