Provider Demographics
NPI:1275658585
Name:DIABETES & ENDOCRINOLOGY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-314-8045
Mailing Address - Street 1:155 E SONTERRA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3988
Mailing Address - Country:US
Mailing Address - Phone:210-314-8045
Mailing Address - Fax:210-314-8073
Practice Address - Street 1:155 E SONTERRA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3988
Practice Address - Country:US
Practice Address - Phone:210-314-8045
Practice Address - Fax:210-314-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141595201Medicaid
TX0051GHOtherBCBS BLUE LINK GROUP NO.
TX141595201Medicaid