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General NPI Number Information
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NPI Number | 1427810340
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Entity Type | Individual
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Provider Name | MR. CLARENCE MAURICE REDRICK
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Gender | Male
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 21750 HARDY OAK BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4925
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Country | US
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Telephone | 210-823-9392
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Fax | 210-783-9156
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Provider Business Mailing Address
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Address Line | 9102 ADDISON RDG
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4480
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Country | US
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Telephone | 210-823-9392
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Fax | 210-783-9156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | E0030CC835FBCFF1
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License Number State | TX
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