Healthcare Provider Details

I. General information

NPI: 1851095970
Provider Name (Legal Business Name): NEPTUNE ANESTHESIA SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19284 STONE OAK PKWY STE 102
SAN ANTONIO TX
78258-3474
US

IV. Provider business mailing address

19141 STONE OAK PKWY STE 104
SAN ANTONIO TX
78258-3367
US

V. Phone/Fax

Practice location:
  • Phone: 210-268-0124
  • Fax: 210-598-4732
Mailing address:
  • Phone: 210-657-4131
  • Fax: 210-598-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MALLIK ARETHIMMAPPA
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-481-8839