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General NPI Number Information
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NPI Number | 1699144881
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Entity Type | Organization
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Legal Business Name | PMPA PLLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 9502 HUEBNER RD SUITE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1649
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Country | US
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Telephone | 210-767-2258
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Fax | 210-767-2259
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Provider Business Mailing Address
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Address Line | 9502 HUEBNER RD SUITE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1649
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Country | US
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Telephone | 210-767-2258
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Fax | 210-767-2259
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTNE VIDOURIA
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Credential | DO
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Telephone | 210-767-2258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | M1395
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License Number State | TX
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