Healthcare Provider Details

I. General information

NPI: 1356572887
Provider Name (Legal Business Name): ROXANNA M. LLANOS-VASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNA M. LLANOS VASQUEZ MD

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9727 POTEET JOURDANTON FWY SUITE 104
SAN ANTONIO TX
78211-4574
US

IV. Provider business mailing address

9727 POTEET JOURDANTON FWY
SAN ANTONIO TX
78211-4574
US

V. Phone/Fax

Practice location:
  • Phone: 210-923-4372
  • Fax: 210-923-5581
Mailing address:
  • Phone: 210-923-4372
  • Fax: 210-923-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9900
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: