Provider Demographics
NPI:1376033951
Name:ESSENTIAL MED CLINIC
Entity Type:Organization
Organization Name:ESSENTIAL MED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBINAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-794-0119
Mailing Address - Street 1:18327 CAMINO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5005
Mailing Address - Country:US
Mailing Address - Phone:305-794-0119
Mailing Address - Fax:
Practice Address - Street 1:2810 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2222
Practice Address - Country:US
Practice Address - Phone:305-794-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty