Healthcare Provider Details

I. General information

NPI: 1740867167
Provider Name (Legal Business Name): LAUREN HATHERALL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18618 TUSCANY STONE STE 120
SAN ANTONIO TX
78258-3465
US

IV. Provider business mailing address

18618 TUSCANY STONE STE 120
SAN ANTONIO TX
78258-3465
US

V. Phone/Fax

Practice location:
  • Phone: 210-201-5677
  • Fax: 210-899-1616
Mailing address:
  • Phone: 210-201-5677
  • Fax: 210-899-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTBD
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: