Provider Demographics
NPI:1356951735
Name:CENTRAL TEXAS DIABETES & WELLNESS INSTITUTE
Entity type:Organization
Organization Name:CENTRAL TEXAS DIABETES & WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN-CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-560-0254
Mailing Address - Street 1:8428 BANDERA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5441 BABCOCK RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-701-8890
Practice Address - Fax:210-783-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty