Provider Demographics
NPI:1669059507
Name:THEODORA KULESZA-GALVEZ MD PA
Entity type:Organization
Organization Name:THEODORA KULESZA-GALVEZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULESZA-GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-452-2669
Mailing Address - Street 1:5414 FREDERICKSBURG RD
Mailing Address - Street 2:STE 260 BLDG B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3763
Mailing Address - Country:US
Mailing Address - Phone:726-600-1775
Mailing Address - Fax:
Practice Address - Street 1:5414 FREDERICKSBURG RD STE 260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3763
Practice Address - Country:US
Practice Address - Phone:210-452-2669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013323450OtherNPI