Provider Demographics
NPI:1154772531
Name:CIELO VISTA MEDICAL PRACTICE P.A.
Entity type:Organization
Organization Name:CIELO VISTA MEDICAL PRACTICE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-683-1329
Mailing Address - Street 1:PO BOX 29408
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0408
Mailing Address - Country:US
Mailing Address - Phone:210-615-1626
Mailing Address - Fax:210-615-1636
Practice Address - Street 1:21604 CIELO RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9604
Practice Address - Country:US
Practice Address - Phone:210-683-1329
Practice Address - Fax:210-615-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8057OtherLICENSE