Provider Demographics
NPI:1710918354
Name:GAONA FAMILY MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:GAONA FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-433-6909
Mailing Address - Street 1:PO BOX 37080
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-0080
Mailing Address - Country:US
Mailing Address - Phone:210-433-7690
Mailing Address - Fax:210-433-6907
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:210-433-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty