Healthcare Provider Details

I. General information

NPI: 1487013983
Provider Name (Legal Business Name): VATANADILOK ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 CORIAN SPRINGS DR
SAN ANTONIO TX
78247-5599
US

IV. Provider business mailing address

4879 CORIAN SPRINGS DR
SAN ANTONIO TX
78247-5599
US

V. Phone/Fax

Practice location:
  • Phone: 210-379-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. TAN VATANADILOK
Title or Position: CEO
Credential: D.N.P.
Phone: 210-379-7340