Provider Demographics
NPI:1780865709
Name:CLINICA MONTERREY PA
Entity Type:Organization
Organization Name:CLINICA MONTERREY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:MARTINEZ-SORIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-827-1014
Mailing Address - Street 1:5138 ASHTON AUDREY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1792
Mailing Address - Country:US
Mailing Address - Phone:210-334-3330
Mailing Address - Fax:210-334-3334
Practice Address - Street 1:5138 ASHTON AUDREY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1792
Practice Address - Country:US
Practice Address - Phone:210-334-3330
Practice Address - Fax:210-334-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158467401Medicaid
TX158468201Medicaid
TX8J9020OtherBCBS
TX0016KKOtherBCBS
TX0016KKOtherBCBS
TX158468201Medicaid
TX8A5097Medicare PIN