Healthcare Provider Details

I. General information

NPI: 1013599117
Provider Name (Legal Business Name): SARA CATHERINE MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14249 POTRANCO RD STE 102
SAN ANTONIO TX
78253-2132
US

IV. Provider business mailing address

277 BUDDY GANEM DR STE A
PORTLAND TX
78374-3202
US

V. Phone/Fax

Practice location:
  • Phone: 210-998-4811
  • Fax: 210-233-8297
Mailing address:
  • Phone: 361-777-3900
  • Fax: 361-413-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: