Provider Demographics
NPI:1962860221
Name:UROLOGY SAN ANTONIO, P.A.
Entity Type:Organization
Organization Name:UROLOGY SAN ANTONIO, P.A.
Other - Org Name:DR JOHNNY REYNA CENTER FOR CANCER TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-731-2050
Mailing Address - Street 1:7718 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3402
Mailing Address - Country:US
Mailing Address - Phone:210-477-9060
Mailing Address - Fax:
Practice Address - Street 1:7718 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3402
Practice Address - Country:US
Practice Address - Phone:210-477-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty