Provider Demographics
NPI:1205151107
Name:JOSE R. REBOLLEDO,M.D.,P.A.
Entity type:Organization
Organization Name:JOSE R. REBOLLEDO,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOLLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-222-2175
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE811
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-222-2175
Mailing Address - Fax:210-222-9374
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 811
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-222-2175
Practice Address - Fax:210-222-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD37492080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty