NPIMap

Organization Active NPI

San Antonio Functional Health PLLC

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1407621964
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAN ANTONIO FUNCTIONAL HEALTH PLLC
Practice address
1602 McCullough Ave
San Antonio, TX 78212-4434
Phone
(210) 468-1891
Fax
(210) 568-4905
NPI assigned
Nov 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jacob Liserio Torres, DCNPI 1689905390
Title
Member
Phone
(210) 468-1891

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1602 McCullough Ave
San Antonio, TX 78212-4434

Mailing address

1602 McCullough Ave
San Antonio, TX 78212-4434
Phone (210) 468-1891

National Provider Directory

National Provider Directory

Locations

1602 McCullough Ave
San Antonio, TX 78212
Phone (210) 468-1891

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1407621964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 MCCULLOUGH AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124434",
            "telephone_number": "210-468-1891",
            "fax_number": "210-568-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 MCCULLOUGH AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124434",
            "telephone_number": "210-468-1891",
            "fax_number": "210-568-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO FUNCTIONAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "TORRES",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "LISERIO",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "210-468-1891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.