| Longevity Clinical Ltc Associates of Texas, PLLC | |
|
8000 W Ih 10 Ste 600 San Antonio TX 78230-3887 | |
| (561) 815-2427 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates of Texas, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 8000 W Ih 10 Ste 600, San Antonio, Texas |
| Authorized Official Name and Position | Diane Vincur (LWC PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates of Texas, PLLC 11780 Us Highway 1 Ste N107 North Palm Beach FL 33408-3007 | Longevity Clinical Ltc Associates of Texas, PLLC 8000 W Ih 10 Ste 600 San Antonio TX 78230-3887 Ph: (561) 815-2427 |
| NPI Number | 1720769698 |
|---|---|
| Provider Enumeration Date | 07/25/2023 |
| Last Update Date | 07/25/2023 |
| Certification Date | 07/25/2023 |
| Medicare PECOS PAC ID | 5597119073 |
|---|---|
| Medicare Enrollment ID | O20231003000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720769698 | NPI | - | NPPES |
| Provider Name | Elizabeth M Leal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285885756 PECOS PAC ID: 2365612702 Enrollment ID: I20110823000436 |
| Provider Name | Bonita Hernandez Saenz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538577440 PECOS PAC ID: 4880918911 Enrollment ID: I20150121000813 |
| Provider Name | Filiberto Gutierrez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225585151 PECOS PAC ID: 5496030249 Enrollment ID: I20170320000157 |
| Provider Name | Jennifer a Tafoya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487299889 PECOS PAC ID: 3072948231 Enrollment ID: I20200115002641 |
| Provider Name | Waseem Ghannam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306080510 PECOS PAC ID: 5092971085 Enrollment ID: I20220428002256 |
| Provider Name | Noemi Gabriela Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487210803 PECOS PAC ID: 5496103905 Enrollment ID: I20231122000487 |
| Provider Name | Olufemi Fanusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003561705 PECOS PAC ID: 4284015215 Enrollment ID: I20240605000964 |
| Provider Name | Rosa Luz Landeros |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861236622 PECOS PAC ID: 7416493911 Enrollment ID: I20240720000025 |
| Provider Name | Valerie Shade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164088597 PECOS PAC ID: 4486987070 Enrollment ID: I20240909002212 |
| Provider Name | Mallory Muzykoski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922595222 PECOS PAC ID: 1254685902 Enrollment ID: I20240910001292 |
| Provider Name | Delisa Mcdavid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063218816 PECOS PAC ID: 3971010141 Enrollment ID: I20250731000172 |
| Provider Name | Patricia Ann Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912043647 PECOS PAC ID: 9739122292 Enrollment ID: I20250911001885 |
| Provider Name | Symone Monyae Franklin-muodinma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740759554 PECOS PAC ID: 1658857081 Enrollment ID: I20260115000966 |
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