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General NPI Number Information
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NPI Number | 1073796736
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Entity Type | Organization
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Legal Business Name | CAN THERA, PA
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 1314 E SONTERRA BLVD SUITE 5101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4278
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Country | US
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Telephone | 210-404-0044
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Fax | 210-404-0045
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Provider Business Mailing Address
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Address Line | 1314 E SONTERRA BLVD SUITE 5101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4278
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Country | US
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Telephone | 210-404-0044
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Fax | 210-404-0045
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Authorized Official
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Title or Position | OWNER
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Name | IRENE KAZHDAN
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Credential | MD
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Telephone | 210-404-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | M0776
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License Number State | TX
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