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General NPI Number Information
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NPI Number | 1093719379
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Entity Type | Organization
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Legal Business Name | PEDIATRIC EAR, NOSE & THROAT INSTITUTE OF SOUTH TEXAS
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 05/09/2011
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Provider Practice Location Address
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Address Line | 16723 HUEBNER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78248-2342
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Country | US
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Telephone | 210-733-4368
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Fax | 210-402-3417
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Provider Business Mailing Address
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Address Line | PO BOX 29749
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City | SAN ANTONIO
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State | TX
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Zip | 78229-0749
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Country | US
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Telephone | 210-733-4368
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Fax | 210-402-3417
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | BENJAMIN SALAZAR
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Credential |
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Telephone | 210-733-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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