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General NPI Number Information
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NPI Number | 1316324692
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Entity Type | Organization
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Legal Business Name | MENS PERFORMANCE HEALTH SA, LLC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 525 OAK CENTRE DR SUITE 230
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3944
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Country | US
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Telephone | 210-267-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 525 OAK CENTRE DR SUITE 230
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3944
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Country | US
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Telephone | 210-267-5400
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TERENCE TERENZI
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Credential |
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Telephone | 210-267-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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