Healthcare Provider Details

I. General information

NPI: 1437767795
Provider Name (Legal Business Name): BEXARAID,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 BROADWAY ST
SAN ANTONIO TX
78215-1117
US

IV. Provider business mailing address

110 E HOUSTON ST # 7TH
SAN ANTONIO TX
78205-2990
US

V. Phone/Fax

Practice location:
  • Phone: 830-582-4029
  • Fax:
Mailing address:
  • Phone: 210-387-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN ALEXANDRA GARZA
Title or Position: MANAGING PARTNER
Credential:
Phone: 830-582-4029