Organization
SOUTHERN TEXAS HEART AND VASCULAR CLINIC, PLLC
Active
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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