=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255451779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY LEO CULOTTA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 03/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 N GENERAL MCMULLEN DR STE 1
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78228-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-249-0212
-----------------------------------------------------
Fax | 210-249-0217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6243 IH 10 W STE 480
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-2086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-731-4800
-----------------------------------------------------
Fax | 210-731-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | F-5507
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------