=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588523534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW EDWARD ANSELMO RRT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2026
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4502 MEDICAL DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-358-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 468 CACTUS FLOWER
-----------------------------------------------------
City | CIBOLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78108-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-685-1269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2279C0205X
-----------------------------------------------------
Taxonomy Name | Critical Care Registered Respiratory Therapist
-----------------------------------------------------
License Number | RCP02001607
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------