Healthcare Provider Details

I. General information

NPI: 1811475817
Provider Name (Legal Business Name): TRU ORTHO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18626 HARDY OAK BLVD STE 101
SAN ANTONIO TX
78258-4210
US

IV. Provider business mailing address

ID# 2163 PO BOX 659506
SAN ANTONIO TX
78265-9506
US

V. Phone/Fax

Practice location:
  • Phone: 210-878-4116
  • Fax: 210-878-4113
Mailing address:
  • Phone: 210-878-4116
  • Fax: 210-878-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM4325
License Number StateTX

VIII. Authorized Official

Name: AMANDA MARSHALL-RODRIGUEZ
Title or Position: MD/OWNER/AUTHORIZED OFFIICAL
Credential: MD
Phone: 210-878-4116