Organization
SOUTHERN TEXAS HEART AND VASCULAR CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN DIEGO MARTINEZ M.D. (MANAGING MEMBER)
(210) 653-0887
Entity
Organization
Contact information
Practice address
12501 JUDSON RD STE 202, LIVE OAK, TX 78233-4117
(210) 599-4086
(210) 655-1401
Mailing address
12709 TOEPPERWEIN RD STE 205, LIVE OAK, TX 78233-3260
(210) 653-0887
(210) 653-0615
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
P0091
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12356656
CAQH
TX
Enumeration date
04/10/2013
Last updated
04/10/2013
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