Healthcare Provider Details

I. General information

NPI: 1063380517
Provider Name (Legal Business Name): ANDREW CHURCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTIANNA CHURCH

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 GREEN SAPPHIRE
SAN ANTONIO TX
78263-4420
US

IV. Provider business mailing address

7211 GREEN SAPPHIRE
SAN ANTONIO TX
78263-4420
US

V. Phone/Fax

Practice location:
  • Phone: 210-708-5690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2910558
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: