Healthcare Provider Details

I. General information

NPI: 1083294516
Provider Name (Legal Business Name): JESSIE ZUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 W INTERSTATE 10
SAN ANTONIO TX
78230-4711
US

IV. Provider business mailing address

7710 W INTERSTATE 10
SAN ANTONIO TX
78230-4711
US

V. Phone/Fax

Practice location:
  • Phone: 210-377-3355
  • Fax:
Mailing address:
  • Phone: 210-377-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA0060054713
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: