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General NPI Number Information
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NPI Number | 1295984870
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Entity Type | Organization
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Legal Business Name | MYWTLOSSSURGEON ASSOCIATES
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 7220 LOUIS PASTEUR DR STE 140
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4537
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Country | US
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Telephone | 210-324-5726
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Fax |
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Provider Business Mailing Address
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Address Line | 22 LAKESIDE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1019
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Country | US
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Telephone | 210-579-0737
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | PARESH K RAJAJOSHIWALA
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Credential | MD
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Telephone | 210-324-5726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | L8481
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License Number State | TX
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