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General NPI Number Information
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NPI Number | 1679706261
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Entity Type | Organization
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Legal Business Name | EAGLE APPLIED SCIENCES, LLC
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Dates
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Enumeration Date | 08/28/2009
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 225 E SONTERRA BLVD SUITE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3992
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Country | US
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Telephone | 210-477-2799
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Fax | 210-490-0017
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Provider Business Mailing Address
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Address Line | 200 CONCORD PLAZA DR SUITE 430
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6943
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Country | US
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Telephone | 210-477-9242
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Fax | 210-581-8609
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. GUY ROBERT BANTA
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Credential | PHD, MPH
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Telephone | 210-477-9242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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