Healthcare Provider Details

I. General information

NPI: 1760279103
Provider Name (Legal Business Name): PRESTON MAINZ PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 GALM RD
SAN ANTONIO TX
78254-9506
US

IV. Provider business mailing address

11615 GALM RD
SAN ANTONIO TX
78254-9506
US

V. Phone/Fax

Practice location:
  • Phone: 940-999-0955
  • Fax:
Mailing address:
  • Phone: 940-999-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number760118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: