Provider Demographics
NPI:1336612274
Name:BROOKS CITY BASE CARDIOVASCULAR
Entity Type:Organization
Organization Name:BROOKS CITY BASE CARDIOVASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-439-7889
Mailing Address - Street 1:4025 E SOUTHCROSS BLVD STE 15
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3641
Mailing Address - Country:US
Mailing Address - Phone:832-439-7889
Mailing Address - Fax:
Practice Address - Street 1:4025 E SOUTHCROSS BLVD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:832-439-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty