Provider Demographics
NPI:1215126743
Name:ELIAS M. PRIETO, MD PA
Entity type:Organization
Organization Name:ELIAS M. PRIETO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-227-0195
Mailing Address - Street 1:730 N MAIN
Mailing Address - Street 2:STE 219
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-297-0195
Mailing Address - Fax:210-925-2455
Practice Address - Street 1:730 N MAIN
Practice Address - Street 2:STE 219
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-297-0195
Practice Address - Fax:210-925-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118037402Medicaid
TX097120202Medicaid