Healthcare Provider Details

I. General information

NPI: 1437967643
Provider Name (Legal Business Name): BINDU SHAJI KOTTANAL RN, BSN, PCCN, CVRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

11811 RANCHWELL CV
SAN ANTONIO TX
78249-3937
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-461-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number735815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: