Healthcare Provider Details

I. General information

NPI: 1164702833
Provider Name (Legal Business Name): LINNELL SLOAN CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14603 HUEBNER RD BLD 28 STE 2801
SAN ANTONIO TX
78230-5469
US

IV. Provider business mailing address

14603 HUEBNER RD BLD 28 STE 2801
SAN ANTONIO TX
78230-5469
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-7074
  • Fax: 210-614-7091
Mailing address:
  • Phone: 210-614-7074
  • Fax: 210-614-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberPF0076
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: