Basic Information
| Provider Information | |||||||||
| NPI: | 1164817946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIMAYA | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 S FLORES ST APT 3059 | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782041209 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11503 NW MILITARY HWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102336363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | S6159 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | S6159 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.