Healthcare Provider Details

I. General information

NPI: 1518919216
Provider Name (Legal Business Name): GIORGIO SANT'AMBROGIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17720 CORPORATE WOODS DR
SAN ANTONIO TX
78259-3500
US

IV. Provider business mailing address

234 W BANDERA RD
BOERNE TX
78006-2805
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-9400
  • Fax:
Mailing address:
  • Phone: 830-755-5221
  • Fax: 830-755-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH6576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: