Healthcare Provider Details

I. General information

NPI: 1396912762
Provider Name (Legal Business Name): ALELI CASINO MASAJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 JACKSON KELLER RD
SAN ANTONIO TX
78213-2722
US

IV. Provider business mailing address

2148 JACKSON KELLER RD
SAN ANTONIO TX
78213-2722
US

V. Phone/Fax

Practice location:
  • Phone: 210-501-0703
  • Fax: 210-526-0334
Mailing address:
  • Phone: 210-501-0703
  • Fax: 210-526-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP3769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: