Provider Demographics
NPI:1003130543
Name:SOUTH TEXAS NEUROPSYCHOLOGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS NEUROPSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ PH.D
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-614-3011
Mailing Address - Street 1:3603 PAESANOS PKWY
Mailing Address - Street 2:STE 300A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1267
Mailing Address - Country:US
Mailing Address - Phone:210-614-3011
Mailing Address - Fax:210-615-6906
Practice Address - Street 1:3603 PAESANOS PKWY
Practice Address - Street 2:STE 300A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1267
Practice Address - Country:US
Practice Address - Phone:210-614-3011
Practice Address - Fax:210-615-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30743103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty