=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245885342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANICA ISIGUZO, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2019
-----------------------------------------------------
Last Update Date | 08/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34910 INTERSTATE 10 W STE 601
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-9230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-248-1207
-----------------------------------------------------
Fax | 830-331-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1936
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78297-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-248-1207
-----------------------------------------------------
Fax | 830-331-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. MANICA ISIGUZO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 830-248-1207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------