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General NPI Number Information
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NPI Number | 1578477469
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Entity Type | Organization
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Legal Business Name | PROACTIVE UMS, INC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 8103 BANDERA RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78250-5185
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Country | US
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Telephone | 210-500-2914
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Fax |
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Provider Business Mailing Address
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Address Line | 3712 VISTA CHASE CT
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City | ARLINGTON
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State | TX
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Zip | 76001-6961
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Country | US
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Telephone | 832-705-2204
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANDY RAUL MANZANO MATOS
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Credential |
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Telephone | 832-705-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | NULL
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