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General NPI Number Information
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NPI Number | 1871371799
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Entity Type | Organization
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Legal Business Name | LUCIDITY OF SAN ANTONIO PLLC
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 8203 TESORO HLS
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City | SAN ANTONIO
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State | TX
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Zip | 78242-1414
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Country | US
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Telephone | 210-400-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 8203 TESORO HLS
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City | SAN ANTONIO
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State | TX
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Zip | 78242-1414
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Country | US
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Telephone | 210-400-1911
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | DOMINGO LOPEZ JR.
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Credential | NP
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Telephone | 210-573-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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