Provider Demographics
NPI:1114323466
Name:NELL MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:NELL MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-510-2868
Mailing Address - Street 1:400 N LOOP 1604 E
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1258
Mailing Address - Country:US
Mailing Address - Phone:210-510-2868
Mailing Address - Fax:210-495-4086
Practice Address - Street 1:400 N LOOP 1604 E
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1258
Practice Address - Country:US
Practice Address - Phone:210-495-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1868261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)