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General NPI Number Information
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NPI Number | 1285456897
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Entity Type | Organization
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Legal Business Name | BETTYSANA WELLNESS LLC
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 5635 TIMBER WAGON
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City | SAN ANTONIO
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State | TX
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Zip | 78250-4150
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Country | US
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Telephone | 956-827-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 7543 GRISSOM RD STE 109B
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City | SAN ANTONIO
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State | TX
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Zip | 78251-2879
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Country | US
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Telephone | 956-452-0671
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Fax | 956-394-1177
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Authorized Official
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Title or Position | OWNER
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Name | YEDLISBETT CEBALLOS GARRETT
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Credential | PA-C
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Telephone | 956-827-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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