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General NPI Number Information
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NPI Number | 1609205137
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Entity Type | Organization
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Legal Business Name | REGINA M FEARMONTI, MD, PA
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 21 SPURS LN STE 120
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1669
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Country | US
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Telephone | 210-616-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 17101 LA CANTERA PKWY 6302
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City | SAN ANTONIO
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State | TX
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Zip | 78256-2484
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Country | US
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Telephone | 713-392-9921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | MS. REGINA MARIE FEARMONTI
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Credential | M.D.
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Telephone | 713-392-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M4776
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License Number State | TX
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