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General NPI Number Information
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NPI Number | 1114024478
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Entity Type | Organization
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Legal Business Name | LETICIA A PORET MD PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 4522 FREDERICKSBURG RD SUITE A 14
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City | SAN ANTONIO
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State | TX
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Zip | 78201-6521
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Country | US
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Telephone | 210-733-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 12627 STONEHENGE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1941
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Country | US
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Telephone | 210-733-3005
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LETICIA ANN PORET
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Credential | MD
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Telephone | 210-733-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H9289
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License Number State | TX
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