Healthcare Provider Details

I. General information

NPI: 1790148708
Provider Name (Legal Business Name): JOEL SARMIENTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W HIGHWAY 71 STE A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

4919 E BEVERLY MAE DR
SAN ANTONIO TX
78229-4937
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax: 512-610-7034
Mailing address:
  • Phone: 936-675-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS0376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: