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General NPI Number Information
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NPI Number | 1740303171
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Entity Type | Individual
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Provider Name | MARIE CECILIA PERUSEK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 88 BRIGGS AVE., SOUTHWEST DIAGNOSTIC CENTER SUITE 110
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City | SAN ANTONIO
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State | TX
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Zip | 78224-4000
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Country | US
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Telephone | 210-921-0902
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Fax | 210-923-8220
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Provider Business Mailing Address
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Address Line | 8310 TIMBER GLEN ST
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City | SAN ANTONIO
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State | TX
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Zip | 78250-4434
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Country | US
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Telephone | 210-647-3272
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Fax | 210-647-1376
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | F9943
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License Number State | TX
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