Healthcare Provider Details

I. General information

NPI: 1386977064
Provider Name (Legal Business Name): GRMNM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 POTRANCO RD STE 122 #195
SAN ANTONIO TX
78251-3330
US

IV. Provider business mailing address

10730 POTRANCO RD STE 122 #195
SAN ANTONIO TX
78251-3330
US

V. Phone/Fax

Practice location:
  • Phone: 210-714-5504
  • Fax:
Mailing address:
  • Phone: 210-714-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LIZETTE MORIN
Title or Position: MDMS NPI COMPLIANCE OFFICER
Credential:
Phone: 210-598-2801