Healthcare Provider Details

I. General information

NPI: 1326203357
Provider Name (Legal Business Name): WUNDERBAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 N HOUSTON AVE STE I
NEW BRAUNFELS TX
78130-4122
US

IV. Provider business mailing address

PO BOX 311059
NEW BRAUNFELS TX
78131-1059
US

V. Phone/Fax

Practice location:
  • Phone: 830-624-7300
  • Fax: 830-626-3100
Mailing address:
  • Phone: 830-625-6916
  • Fax: 830-625-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. OLAF J.A.S. HAERENS
Title or Position: VICE PRESIDENT
Credential: D.D.S.
Phone: 830-626-3100