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General NPI Number Information
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NPI Number | 1265118806
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Entity Type | Organization
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Legal Business Name | SHALOM FAMILY AND WEIGHT LOSS CLINIC, PLLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2819 NW LOOP 410 STE A
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5105
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Country | US
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Telephone | 210-500-8639
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Fax | 210-783-9179
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Provider Business Mailing Address
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Address Line | 8514 KALLISON ARBOR
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4557
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Country | US
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Telephone | 512-568-9636
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Fax | 210-783-9179
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Authorized Official
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Title or Position | OWNER/FNP
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Name | MRS. AMY J WILLIAMS
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Credential | FNP-BC
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Telephone | 210-500-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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