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General NPI Number Information
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NPI Number | 1578793865
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Entity Type | Organization
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Legal Business Name | RAPHA SURGICAL MANAGEMENT ORGANIZATION LLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 5835 CALLAGHAN RD SUITE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1125
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Country | US
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Telephone | 210-264-4511
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14237
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City | SAN ANTONIO
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State | TX
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Zip | 78214-0237
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Country | US
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Telephone | 210-467-2005
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ROMO PARDO
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Credential |
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Telephone | 210-467-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E3339
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License Number State | TX
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