Provider Demographics
NPI:1558427989
Name:BUENA VISTA FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:BUENA VISTA FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-226-6562
Mailing Address - Street 1:1712 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3803
Mailing Address - Country:US
Mailing Address - Phone:210-226-6562
Mailing Address - Fax:210-222-8366
Practice Address - Street 1:1712 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3803
Practice Address - Country:US
Practice Address - Phone:210-226-6562
Practice Address - Fax:210-222-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE20350Medicare UPIN
TX00681YMedicare PIN