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General NPI Number Information
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NPI Number | 1205067907
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Entity Type | Organization
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Legal Business Name | WENDY BACA M.D.P.A.
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 7049 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6209
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Country | US
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Telephone | 210-342-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65165
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City | SAN ANTONIO
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State | TX
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Zip | 78265-5165
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Country | US
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Telephone | 830-379-9600
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Fax | 830-303-5033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WENDY BACA
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Credential | MD
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Telephone | 210-380-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | K4359
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License Number State | TX
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