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General NPI Number Information
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NPI Number | 1215947635
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Entity Type | Organization
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Legal Business Name | LISARA DIAGNOSTICS
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7220 LOUIS PASTEUR DR STE 160 STE 160
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4535
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Country | US
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Telephone | 210-614-3003
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Fax | 210-692-7898
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Provider Business Mailing Address
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Address Line | 4319 MEDICAL DR # 131-113
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3381
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Country | US
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Telephone | 210-614-3003
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Fax | 210-692-7898
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA ANN QUINTANILLA
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Credential |
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Telephone | 210-614-3003
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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 | L2885
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License Number State | TX
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