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General NPI Number Information
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NPI Number | 1568172104
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Entity Type | Organization
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Legal Business Name | MI VIDA DIAGNOSTICS PLLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 18816 FM 2252 STE B
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City | SAN ANTONIO
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State | TX
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Zip | 78266-2853
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Country | US
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Telephone | 210-823-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 18816 FM 2252 STE B
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City | SAN ANTONIO
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State | TX
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Zip | 78266-2853
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Country | US
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Telephone | 210-823-0100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY HERNANDEZ
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Credential | FNP
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Telephone | 210-550-4533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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