Healthcare Provider Details

I. General information

NPI: 1518187327
Provider Name (Legal Business Name): VERA L MCDADE OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8343 HASTINGS
SAN ANTONIO TX
78239-2834
US

IV. Provider business mailing address

8343 HASTINGS
SAN ANTONIO TX
78239-2834
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-6407
  • Fax: 210-654-6407
Mailing address:
  • Phone: 210-654-6407
  • Fax: 210-654-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number1014371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: