Provider Demographics
NPI:1023016177
Name:BACA, WENDY (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:BACA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65165
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-5165
Mailing Address - Country:US
Mailing Address - Phone:210-377-3937
Mailing Address - Fax:
Practice Address - Street 1:10935 WURZBACH
Practice Address - Street 2:#202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-377-3937
Practice Address - Fax:210-342-2375
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4359207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CC564OtherBLUE CROSS OF TEXAS
TX8F22359OtherMEDICARE IND PTAN
TX8F22359OtherMEDICARE IND PTAN
TXG78812Medicare UPIN