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General NPI Number Information
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NPI Number | 1477558179
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Entity Type | Organization
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Legal Business Name | IMMUNO D, INC.
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8122 DATAPOINT DR STE 910
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3273
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Country | US
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Telephone | 210-614-5809
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Fax | 210-615-8186
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Provider Business Mailing Address
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Address Line | 8122 DATAPOINT DR STE 910
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3273
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Country | US
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Telephone | 210-614-5809
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Fax | 210-615-8186
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Authorized Official
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Title or Position | CFO
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Name | MS. LYNDA ATWOOD
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Credential |
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Telephone | 210-614-5809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | TX
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