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General NPI Number Information
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NPI Number | 1023016177
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Entity Type | Individual
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Provider Name | WENDY BACA MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10935 WURZBACH #202
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City | SAN ANTONIO
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State | TX
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Zip | 78230
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Country | US
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Telephone | 210-377-3937
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Fax | 210-342-2375
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Provider Business Mailing Address
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Address Line | PO BOX 65165
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City | SAN ANTONIO
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State | TX
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Zip | 78265-5165
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Country | US
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Telephone | 210-377-3937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | K4359
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License Number State | TX
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