Healthcare Provider Details

I. General information

NPI: 1063061414
Provider Name (Legal Business Name): HOSPITAL SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARETERA 23
CHAPALA JA
45920
MX

IV. Provider business mailing address

539 W COMMERCE ST STE 43200
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone: 888-449-7799
  • Fax: 888-449-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: JAVIER EZQUERRA
Title or Position: LEGAL REPRESENTATIVE
Credential: DR
Phone: 888-449-7799