Healthcare Provider Details

I. General information

NPI: 1902881071
Provider Name (Legal Business Name): SAN ANTONIO PET PARTNERSHIP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9102 FLOYD CURL DR SUITE 193
SAN ANTONIO TX
78240-1553
US

IV. Provider business mailing address

9102 FLOYD CURL DR SUITE 193
SAN ANTONIO TX
78240-1553
US

V. Phone/Fax

Practice location:
  • Phone: 210-247-0895
  • Fax: 210-558-0758
Mailing address:
  • Phone: 210-247-0895
  • Fax: 210-558-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY ROBERT PRESTIDGE
Title or Position: OWNER
Credential: MD
Phone: 210-247-0895