Provider Demographics
NPI:1518097971
Name:ARRIOLA, HOMERO C (MD)
Entity Type:Individual
Prefix:
First Name:HOMERO
Middle Name:C
Last Name:ARRIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3727
Mailing Address - Country:US
Mailing Address - Phone:210-337-4316
Mailing Address - Fax:210-337-4380
Practice Address - Street 1:4243 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3727
Practice Address - Country:US
Practice Address - Phone:210-337-4316
Practice Address - Fax:210-337-4380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123902205Medicaid
TXC12974Medicare UPIN
TX8B2235Medicare ID - Type Unspecified