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General NPI Number Information
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NPI Number | 1730557901
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Entity Type | Organization
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Legal Business Name | EVQV,LLC
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 2601 PLEASANTON RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1802
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Country | US
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Telephone | 210-858-9320
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Fax | 210-858-6650
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Provider Business Mailing Address
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Address Line | 2601 PLEASANTON RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1802
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Country | US
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Telephone | 210-858-9320
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Fax | 210-858-6650
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL WEBB
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Credential | SHOE FITTER
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Telephone | 210-858-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 3-2053-0088
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License Number State | TX
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