Provider Demographics
NPI:1710030580
Name:GAONA MEDICAL FAMILY CLINIC INC
Entity Type:Organization
Organization Name:GAONA MEDICAL FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADM
Authorized Official - Prefix:
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-433-9111
Mailing Address - Street 1:1805 CASTROVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3659
Mailing Address - Country:US
Mailing Address - Phone:210-433-6909
Mailing Address - Fax:210-433-2745
Practice Address - Street 1:1805 CASTROVILLE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3659
Practice Address - Country:US
Practice Address - Phone:210-433-6909
Practice Address - Fax:210-433-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4124363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22867Medicare UPIN