Provider Demographics
NPI:1942319660
Name:ALAMO DIABETES TEAM, LLP
Entity Type:Organization
Organization Name:ALAMO DIABETES TEAM, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERNESTINE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDE
Authorized Official - Phone:210-733-0200
Mailing Address - Street 1:PO BOX 701986
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1986
Mailing Address - Country:US
Mailing Address - Phone:210-733-0200
Mailing Address - Fax:210-733-6202
Practice Address - Street 1:14747 OAK BRIAR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4679
Practice Address - Country:US
Practice Address - Phone:210-733-0200
Practice Address - Fax:210-733-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00357UMedicare ID - Type Unspecified