Healthcare Provider Details

I. General information

NPI: 1629123682
Provider Name (Legal Business Name): IZABELA TARASIEWICZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MADISON OAK DR STE 346
SAN ANTONIO TX
78258-4084
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-6027
  • Fax:
Mailing address:
  • Phone: 210-567-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberQ3600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: