=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770057739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REEM RAZEQ PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2019
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3503 PAESANOS PKWY STE 201
-----------------------------------------------------
City | SHAVANO PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78231-1225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-504-3650
-----------------------------------------------------
Fax | 210-519-3045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3503 PAESANOS PKWY STE 201
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78231-1225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-589-7386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA12334
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------