Healthcare Provider Details

I. General information

NPI: 1780104679
Provider Name (Legal Business Name): PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 LOUIS PASTEUR SUITE 144
SAN ANTONIO TX
78229-4534
US

IV. Provider business mailing address

2101 N 23RD ST
MCALLEN TX
78501-6127
US

V. Phone/Fax

Practice location:
  • Phone: 210-290-9335
  • Fax: 210-290-9623
Mailing address:
  • Phone: 956-687-4555
  • Fax: 956-687-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD R CANALES
Title or Position: COO
Credential:
Phone: 956-687-4559