Healthcare Provider Details

I. General information

NPI: 1255802278
Provider Name (Legal Business Name): BIENESTAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11503 JONES MALTSBERGER RD STE 1106
SAN ANTONIO TX
78216-2630
US

IV. Provider business mailing address

11503 JONES MALTSBERGER RD STE 1106
SAN ANTONIO TX
78216-2630
US

V. Phone/Fax

Practice location:
  • Phone: 210-344-5651
  • Fax: 210-547-7902
Mailing address:
  • Phone: 210-344-5651
  • Fax: 210-547-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. EUNICE ADVINCULA
Title or Position: CREDENTIALING
Credential: CREDENTIALING DEPT.
Phone: 562-403-4422