Healthcare Provider Details

I. General information

NPI: 1003130543
Provider Name (Legal Business Name): SOUTH TEXAS NEUROPSYCHOLOGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 PAESANOS PKWY STE 300A
SAN ANTONIO TX
78231-1267
US

IV. Provider business mailing address

3603 PAESANOS PKWY STE 300A
SAN ANTONIO TX
78231-1267
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-3011
  • Fax: 210-615-6906
Mailing address:
  • Phone: 210-614-3011
  • Fax: 210-615-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number30743
License Number StateTX

VIII. Authorized Official

Name: GILBERT MARTINEZ PH.D
Title or Position: PRESIDENT
Credential: PH.D
Phone: 210-614-3011