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General NPI Number Information
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NPI Number | 1124578018
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Entity Type | Organization
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Legal Business Name | ALISON WIESENTHAL, MD, PA
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 333 W OLMOS DR
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City | SAN ANTONIO
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State | TX
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Zip | 78212-1959
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Country | US
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Telephone | 210-831-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 333 W OLMOS DR
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City | SAN ANTONIO
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State | TX
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Zip | 78212-1959
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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 | PHYSICIAN
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Name | DR. ALISON WIESENTHAL
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Credential |
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Telephone | 210-831-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | P3099
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License Number State | TX
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