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General NPI Number Information
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NPI Number | 1073963526
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO ALLERGENIC AND WELLNESS LLC
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 9023 HUEBNER RD STE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2071
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Country | US
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Telephone | 512-201-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 9023 HUEBNER RD STE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2071
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Country | US
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Telephone | 512-201-2668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN NELSON
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Credential |
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Telephone | 512-680-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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