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General NPI Number Information
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NPI Number | 1508432121
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Entity Type | Organization
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Legal Business Name | HEADACHE CLINIC OF SAN ANTONIO LLC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 6333 DE ZAVALA RD STE A250
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2115
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Country | US
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Telephone | 210-727-7364
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Fax | 817-890-9449
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Provider Business Mailing Address
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Address Line | 18523 GOLDEN MAIZE
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City | SAN ANTONIO
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State | TX
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Zip | 78258-1647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA L. CASTRO
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Credential |
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Telephone | 210-727-7364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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