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General NPI Number Information
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NPI Number | 1548575707
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY OF NORTHEAST SAN ANTONIO
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 19315 NACOGDOCHES RD STE. 305
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City | SAN ANTONIO
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State | TX
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Zip | 78266-2516
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Country | US
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Telephone | 210-656-4216
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Fax | 210-656-4217
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Provider Business Mailing Address
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Address Line | 19315 NACOGDOCHES RD STE. 305
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City | SAN ANTONIO
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State | TX
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Zip | 78266-2516
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Country | US
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Telephone | 210-656-4216
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Fax | 210-656-4217
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Authorized Official
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Title or Position | DR.'S ASSISTANT/ BILLING PERSONEL
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Name | MRS. MARY E FLORES
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Credential |
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Telephone | 210-656-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | K7278
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License Number State | TX
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