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General NPI Number Information
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NPI Number | 1720245665
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Entity Type | Organization
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Legal Business Name | THE PLASTIC AND COSMETIC CENTER OF SOUTH TEXAS
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 7272 WURZBACH RD UNITE 801
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City | SAN ANTONIO
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State | TX
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Zip | 78240-4801
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Country | US
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Telephone | 210-270-8595
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Fax | 210-270-8988
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Provider Business Mailing Address
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Address Line | 7272 WURZBACH RD UNIT 801
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City | SAN ANTONIO
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State | TX
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Zip | 78240-4801
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Country | US
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Telephone | 210-270-8595
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Fax | 210-270-8595
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS TAYF JENEBY
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Credential |
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Telephone | 210-270-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9748
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License Number State | TX
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