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General NPI Number Information
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NPI Number | 1801846068
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Entity Type | Individual
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Provider Name | JUAN SAYSON PICO D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 12702 N IH 35
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City | LIVE OAK
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State | TX
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Zip | 78233-2609
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Country | US
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Telephone | 210-650-9669
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Fax | 210-650-0750
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Provider Business Mailing Address
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Address Line | 8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3311
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Country | US
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Telephone | 210-650-9669
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Fax | 210-650-0750
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0102049959
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L5514
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License Number State | TX
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