Provider Demographics
NPI:1962708917
Name:SAN GABRIEL FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:SAN GABRIEL FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTIN-WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-986-8858
Mailing Address - Street 1:921 W NEW HOPE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6784
Mailing Address - Country:US
Mailing Address - Phone:512-986-8858
Mailing Address - Fax:512-986-8853
Practice Address - Street 1:921 W NEW HOPE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6784
Practice Address - Country:US
Practice Address - Phone:512-986-8858
Practice Address - Fax:512-986-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1984261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396777355OtherNPI