Healthcare Provider Details

I. General information

NPI: 1922368356
Provider Name (Legal Business Name): SAN ANTONIO TMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16019 VIA SHAVANO
SAN ANTONIO TX
78249-2370
US

IV. Provider business mailing address

16019 VIA SHAVANO
SAN ANTONIO TX
78249-2370
US

V. Phone/Fax

Practice location:
  • Phone: 210-764-0054
  • Fax: 210-690-8815
Mailing address:
  • Phone: 210-764-0054
  • Fax: 210-690-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberK8047
License Number StateTX

VIII. Authorized Official

Name: DR. JUAN IGNACIO CAMPOS
Title or Position: MANAGER
Credential: M.D.
Phone: 210-380-3107