=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366472250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O'NEILL & ASSOCIATES P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 MCCULLOUGH AVE 125
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78212-5609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-223-5543
-----------------------------------------------------
Fax | 210-223-6830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1303 MCCULLOUGH AVE 125
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78212-5609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-223-5543
-----------------------------------------------------
Fax | 210-223-6830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARVIN SAM BELASCO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-223-5543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | R06817
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------