Healthcare Provider Details

I. General information

NPI: 1730466806
Provider Name (Legal Business Name): LAUREN BACKER DEL BOSQUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BACKER CARDINAL

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

315 N SAN SABA STE 1135
SAN ANTONIO TX
78207-3255
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-2686
  • Fax:
Mailing address:
  • Phone: 210-704-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015239
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: