Healthcare Provider Details

I. General information

NPI: 1144735002
Provider Name (Legal Business Name): ELFADIL ABDELMAGID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 MAVERICK BLUFF ST
SAN ANTONIO TX
78247-3901
US

IV. Provider business mailing address

12205 MAVERICK BLUFF ST
SAN ANTONIO TX
78247-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-636-8685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: