Provider Demographics
NPI:1316964745
Name:GONIMA, CAMILO ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:ALBERTO
Last Name:GONIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 ARION PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2880
Mailing Address - Country:US
Mailing Address - Phone:210-349-9300
Mailing Address - Fax:210-366-2558
Practice Address - Street 1:7940 FLOYD CURL DR
Practice Address - Street 2:SUITE 900
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3906
Practice Address - Country:US
Practice Address - Phone:210-614-1000
Practice Address - Fax:210-615-1236
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153057803Medicaid
TX153057803Medicaid