Healthcare Provider Details

I. General information

NPI: 1033466719
Provider Name (Legal Business Name): INNATE ABILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 FM 2673
CANYON LAKE TX
78133-4743
US

IV. Provider business mailing address

1742 FM 2673
CANYON LAKE TX
78133-4743
US

V. Phone/Fax

Practice location:
  • Phone: 830-964-3032
  • Fax: 830-964-4460
Mailing address:
  • Phone: 830-964-3032
  • Fax: 830-964-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number11974
License Number StateTX

VIII. Authorized Official

Name: DR. JEFFREY Q HARPER
Title or Position: OWNER
Credential: DC
Phone: 830-964-3032