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General NPI Number Information
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NPI Number | 1215268248
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Entity Type | Organization
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Legal Business Name | RIVER CITY ORTHOTICS AND PROSTHETICS, LLC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 16607 BLANCO RD SUITE 303
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1940
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Country | US
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Telephone | 210-485-1844
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Fax | 210-439-9504
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Provider Business Mailing Address
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Address Line | 16607 BLANCO ROAD SUITE 303
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1940
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Country | US
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Telephone | 210-485-1844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID BERARDELLI
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Credential |
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Telephone | 210-485-1844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 209-10982
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License Number State | TX
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