Healthcare Provider Details

I. General information

NPI: 1619849676
Provider Name (Legal Business Name): THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

IV. Provider business mailing address

8431 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3392
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3985
  • Fax: 210-358-5942
Mailing address:
  • Phone: 210-450-4621
  • Fax: 210-450-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: REGINA LYNN DETTY
Title or Position: SR DIRECTOR, MED STAFF SERVICE
Credential:
Phone: 210-450-4736