Healthcare Provider Details

I. General information

NPI: 1346574688
Provider Name (Legal Business Name): ANTONIO HOMERO CRISPIN RADIOLGY TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 S ZARZAMORA ST
SAN ANTONIO TX
78211-3202
US

IV. Provider business mailing address

6111 S ZARZAMORA ST
SAN ANTONIO TX
78211-3202
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-0812
  • Fax: 210-921-1006
Mailing address:
  • Phone: 210-921-0812
  • Fax: 210-921-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: