Organization
CLINICA FAMILIAR BANDERA LLC
Active
Other names
Proactive Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY RAUL MANZANO MATOS (CEO / MANAGING MEMBER)
(832) 705-2204
Entity
Organization
Contact information
Practice address
8103 BANDERA RD STE 102, SAN ANTONIO, TX 78250-5185
(210) 500-2914
Mailing address
12134 STONEY CV, SAN ANTONIO, TX 78247-4918
(832) 705-2204
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
07/25/2026
Last updated
07/25/2026
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