Healthcare Provider Details

I. General information

NPI: 1205399086
Provider Name (Legal Business Name): ANNALISA LARRALDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SW 36TH ST
SAN ANTONIO TX
78237-3360
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-5100
  • Fax: 210-358-5157
Mailing address:
  • Phone: 210-358-5906
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT9731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: