Provider Demographics
NPI:1609425115
Name:GOOD HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:GOOD HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:210-422-2336
Mailing Address - Street 1:505 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1335
Mailing Address - Country:US
Mailing Address - Phone:210-422-2336
Mailing Address - Fax:210-932-2566
Practice Address - Street 1:505 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1335
Practice Address - Country:US
Practice Address - Phone:210-932-2565
Practice Address - Fax:210-932-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710038625Medicaid