Healthcare Provider Details

I. General information

NPI: 1205093606
Provider Name (Legal Business Name): TERESA IDOUX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 E COMMERCE ST
SAN ANTONIO TX
78220-1013
US

IV. Provider business mailing address

3066 E COMMERCE ST
SAN ANTONIO TX
78220-1013
US

V. Phone/Fax

Practice location:
  • Phone: 210-233-7000
  • Fax: 210-277-6387
Mailing address:
  • Phone: 210-233-7000
  • Fax: 210-277-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12899
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number792533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: