Healthcare Provider Details

I. General information

NPI: 1093073074
Provider Name (Legal Business Name): EDUARDO GALVAN FARIAS CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 RAINTREE GRV LOT 2
ELMENDORF TX
78112-7900
US

IV. Provider business mailing address

6951 RAINTREE GRV LOT 2
ELMENDORF TX
78112-7900
US

V. Phone/Fax

Practice location:
  • Phone: 210-787-9552
  • Fax: 210-635-9279
Mailing address:
  • Phone: 210-787-9552
  • Fax: 210-635-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: