Healthcare Provider Details

I. General information

NPI: 1326230160
Provider Name (Legal Business Name): PAIN & RECOVERY CLINIC OF SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 CITIZENS PKWY SUITE 225
SAN ANTONIO TX
78229-3620
US

IV. Provider business mailing address

6851 CITIZENS PKWY SUITE 225
SAN ANTONIO TX
78229-3620
US

V. Phone/Fax

Practice location:
  • Phone: 210-299-1444
  • Fax: 210-299-1446
Mailing address:
  • Phone: 210-299-1444
  • Fax: 210-299-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberDC8690
License Number StateTX

VIII. Authorized Official

Name: MRS. DIANA H PERALES
Title or Position: CUSTODIAN OF RECORDS
Credential:
Phone: 210-299-1444