Healthcare Provider Details

I. General information

NPI: 1093219107
Provider Name (Legal Business Name): PRIESTLEYS DIVINE CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 WISTERIA HL
SAN ANTONIO TX
78218-3108
US

IV. Provider business mailing address

6134 WISTERIA HL
SAN ANTONIO TX
78218-3108
US

V. Phone/Fax

Practice location:
  • Phone: 210-279-7839
  • Fax:
Mailing address:
  • Phone: 210-794-3259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: ZABRINA C GIBSON OHANWE
Title or Position: PRESIDENT/CO
Credential:
Phone: 210-794-3259