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General NPI Number Information
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NPI Number | 1689965287
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Entity Type | Organization
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Legal Business Name | THE SARAH ELAINE WELLNESS CENTER OF SOUTH TEXAS, INC.
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 7103 W BEVERLY MAE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4943
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Country | US
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Telephone | 210-789-3487
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Fax | 210-615-7096
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Provider Business Mailing Address
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Address Line | 7103 W BEVERLY MAE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4943
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Country | US
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Telephone | 210-789-3487
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Fax | 210-615-7096
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. DANIEL HERNANDEZ SR.
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Credential | LCSW
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Telephone | 210-789-3487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 32412
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License Number State | TX
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