Healthcare Provider Details

I. General information

NPI: 1346722899
Provider Name (Legal Business Name): MARIELA OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 CROWNHILL BLVD STE 300
SAN ANTONIO TX
78209-1128
US

IV. Provider business mailing address

10614 GENTLE FOX BAY
SAN ANTONIO TX
78245-2489
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-5530
  • Fax: 210-824-5323
Mailing address:
  • Phone: 210-760-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number304395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: