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NPI Code Detail

MEDICARE: EDUARDO GONZALEZ VADELL LSA

MEDICARE: EDUARDO GONZALEZ VADELL LSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant17-247TX

General Provider Information

NPI Number : 1003344474
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDUARDO GONZALEZ VADELL LSA
Provider Business Mailing Address
First Line : 18756 STONE OAK PKWY STE 200
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4354
Country : US
Telephone Number : 210-998-5527
Fax Number : 210-579-8601
Provider Business Practice Location Address
First Line : 18756 STONE OAK PKWY STE 200
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4354
Country : US
Telephone Number : 210-998-5527
Fax Number : 210-579-8601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2017
Last Update Date : 12/13/2019

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