Provider Demographics
NPI:1073598520
Name:REBOLLAR, CARIDAD M (MD)
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:M
Last Name:REBOLLAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6254
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-395-4012
Practice Address - Street 1:2902 GOLIAD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3958
Practice Address - Country:US
Practice Address - Phone:210-337-4911
Practice Address - Fax:210-337-7749
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-05-05
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Provider Licenses
StateLicense IDTaxonomies
TXK3419207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1182636-05Medicaid
TX118263603Medicaid
TX110207848OtherMEDICARE RAILROAD
TX110207848OtherMEDICARE RAILROAD