Healthcare Provider Details

I. General information

NPI: 1316438344
Provider Name (Legal Business Name): SWAN WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14603 HUEBNER RD STE 2602
SAN ANTONIO TX
78230-5495
US

IV. Provider business mailing address

215 SWEET
SAN ANTONIO TX
78204-1532
US

V. Phone/Fax

Practice location:
  • Phone: 210-888-1436
  • Fax: 210-783-9343
Mailing address:
  • Phone: 210-888-1436
  • Fax: 210-783-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN ESCOTO GUERRERO
Title or Position: PRESIDENT
Credential: MSAOM
Phone: 210-379-2509