Healthcare Provider Details

I. General information

NPI: 1932122348
Provider Name (Legal Business Name): LISA M. FICHTEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E SONTERRA BLVD SUITE 200
SAN ANTONIO TX
78258-3987
US

IV. Provider business mailing address

155 E SONTERRA BLVD SUITE 200
SAN ANTONIO TX
78258-3987
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-5700
  • Fax: 210-593-2664
Mailing address:
  • Phone: 210-593-5700
  • Fax: 210-593-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberJ2000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: