Healthcare Provider Details

I. General information

NPI: 1811657000
Provider Name (Legal Business Name): JUAN R CHAMBERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

IV. Provider business mailing address

10418 PALMERA
HELOTES TX
78023-2020
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-7733
  • Fax: 210-599-3105
Mailing address:
  • Phone: 210-324-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number208088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: