Healthcare Provider Details

I. General information

NPI: 1891141065
Provider Name (Legal Business Name): ROBERT CARRION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 FREDERICKSBURG RD
SAN ANTONIO TX
78201-5552
US

IV. Provider business mailing address

2800 MONTEREY ST
SAN ANTONIO TX
78207-4127
US

V. Phone/Fax

Practice location:
  • Phone: 210-592-3084
  • Fax:
Mailing address:
  • Phone: 210-287-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number32059960263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: