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NPI Code Detail

MEDICARE: BRENDAN COLE LARKIN

MEDICARE: BRENDAN COLE LARKIN
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
11710I1003XIndependent Duty Medical Technicians

General Provider Information

NPI Number : 1275121931
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDAN COLE LARKIN
Provider Business Mailing Address
First Line : 6202 ROXBURY DR APT 5105
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78238-1451
Country : US
Telephone Number : 419-654-3906
Fax Number :
Provider Business Practice Location Address
First Line : 1515 TRUEMPER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78236-5583
Country : US
Telephone Number : 419-654-3906
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2021
Last Update Date : 01/07/2021

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Directions to “ BRENDAN COLE LARKIN ” Practice Location

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