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General NPI Number Information
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NPI Number | 1407621964
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO FUNCTIONAL HEALTH PLLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1602 MCCULLOUGH AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4434
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Country | US
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Telephone | 210-468-1891
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Fax | 210-568-4905
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Provider Business Mailing Address
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Address Line | 1602 MCCULLOUGH AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4434
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Country | US
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Telephone | 210-468-1891
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Fax | 210-568-4905
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JACOB LISERIO TORRES
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Credential | DC
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Telephone | 210-468-1891
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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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