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General NPI Number Information
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NPI Number | 1811794241
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Entity Type | Organization
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Legal Business Name | NORTH STAR HOLISTICS, LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 8135 NUBE MEDINA
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City | SAN ANTONIO
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State | TX
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Zip | 78252-4810
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Country | US
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Telephone | 210-262-7092
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Fax |
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Provider Business Mailing Address
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Address Line | 21750 HARDY OAK BLVD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4946
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Country | US
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Telephone | 210-262-7092
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JUSTO CISNEROS
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Credential | MD
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Telephone | 210-262-7092
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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 |
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License Number State |
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