Healthcare Provider Details

I. General information

NPI: 1194085647
Provider Name (Legal Business Name): IGATUNDU-TEXAS HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 NUTMEG TRL
SAN ANTONIO TX
78238-2324
US

IV. Provider business mailing address

5404 NUTMEG TRL
SAN ANTONIO TX
78238-2324
US

V. Phone/Fax

Practice location:
  • Phone: 210-744-4336
  • Fax:
Mailing address:
  • Phone: 210-744-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. WILSON GATUNDU
Title or Position: DIRECTOR
Credential:
Phone: 210-744-4336