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General NPI Number Information
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NPI Number | 1093531014
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Entity Type | Individual
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Provider Name | JUAN LUIS CARRIEDO BS CNMT
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Gender | Male
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 623 KAMPMANN BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78201-4834
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Country | US
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Telephone | 210-701-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 623 KAMPMANN BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78201-4834
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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 |
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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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 023457
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 023457
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License Number State | TX
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