Healthcare Provider Details

I. General information

NPI: 1558841171
Provider Name (Legal Business Name): PATRICIA G GUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 W HAUSMAN RD
SAN ANTONIO TX
78249-1650
US

IV. Provider business mailing address

111 WILLOW GROVE DR
SAN ANTONIO TX
78245-2788
US

V. Phone/Fax

Practice location:
  • Phone: 210-349-3070
  • Fax: 210-349-0097
Mailing address:
  • Phone: 210-264-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number191671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: