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General NPI Number Information
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NPI Number | 1720342454
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Entity Type | Organization
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Legal Business Name | PERSONALIZED PRESCRIPTION PHYSICIANS, LLC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 7800 IH 10 WEST SUITE 612
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City | SAN ANTONIO
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State | TX
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Zip | 78230
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Country | US
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Telephone | 210-253-9947
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40116
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City | SAN ANTONIO
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State | TX
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Zip | 78229-1116
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Country | US
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Telephone | 210-253-9947
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. REGINALD EWESUEDO
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Credential | M.D
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Telephone | 210-625-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number | N2069
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License Number State | TX
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