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General NPI Number Information
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NPI Number | 1003175662
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Entity Type | Organization
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Legal Business Name | ALEXIS WIESENTHAL MD PA
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 8038 WURZBACH RD STE 320
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3813
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Country | US
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Telephone | 210-614-3365
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6627
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City | SAN ANTONIO
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State | TX
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Zip | 78209-0627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXIS WIESENTHAL
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Credential | M.D.
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Telephone | 210-857-3767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N1219
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | N1219
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License Number State | TX
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