Healthcare Provider Details

I. General information

NPI: 1902398365
Provider Name (Legal Business Name): SOUTH TEXAS SKIN CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 BROADWAY ST STE 300 SOUTH
SAN ANTONIO TX
78215-1137
US

IV. Provider business mailing address

2632 BROADWAY ST STE 300S
SAN ANTONIO TX
78215-1137
US

V. Phone/Fax

Practice location:
  • Phone: 210-558-6234
  • Fax: 210-446-5039
Mailing address:
  • Phone: 210-558-6234
  • Fax: 210-446-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A. FLORES
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 210-890-1508