Healthcare Provider Details

I. General information

NPI: 1720008527
Provider Name (Legal Business Name): SPCSA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 WISEMAN BLVD STE 101
SAN ANTONIO TX
78251-4402
US

IV. Provider business mailing address

P.O. BOX 117614
CAROLLTON TX
75011-7614
US

V. Phone/Fax

Practice location:
  • Phone: 210-615-1901
  • Fax: 210-615-1905
Mailing address:
  • Phone: 210-615-1901
  • Fax: 210-615-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: SERGIO JOSE ALVARADO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 210-576-7246