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General NPI Number Information
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NPI Number | 1598543753
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Entity Type | Organization
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Legal Business Name | IMMUNO, PA
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 21727 IH 10 W STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78257-2108
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Country | US
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Telephone | 210-899-6856
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Fax |
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Provider Business Mailing Address
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Address Line | 21727 IH 10 W STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78257-2108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | ARACELI ELIZALDE
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Credential |
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Telephone | 210-899-6856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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