Healthcare Provider Details

I. General information

NPI: 1134775018
Provider Name (Legal Business Name): UROGYNECOLOGY OF SAN ANTONIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E SONTERRA BLVD STE 170
SAN ANTONIO TX
78258-4068
US

IV. Provider business mailing address

335 E SONTERRA BLVD STE 170
SAN ANTONIO TX
78258-4068
US

V. Phone/Fax

Practice location:
  • Phone: 210-525-1668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASH DABBOUS
Title or Position: SOLE MEMBER
Credential: MD
Phone: 210-525-1668