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NPI Code Detail

MEDICARE: BABCOCK WELLNESS & REJUVENATION PLLC

MEDICARE: BABCOCK WELLNESS & REJUVENATION PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1083463053
Entity Type Code : Organization
Provider Name (Legal Business Name) : BABCOCK WELLNESS & REJUVENATION PLLC
Provider Business Mailing Address
First Line : 6423 BABCOCK RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2950
Country : US
Telephone Number : 210-544-5715
Fax Number : 210-544-5716
Provider Business Practice Location Address
First Line : 6423 BABCOCK RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2950
Country : US
Telephone Number : 210-544-5715
Fax Number : 210-544-5716
Authorized Official
Title or Position : OWNER
Name : EZARA GUTIERREZ
Credential : DO
Telephone Number : 210-544-5715
Provider Enumeration Date : 05/14/2024
Last Update Date : 05/14/2024

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Directions to “BABCOCK WELLNESS & REJUVENATION PLLC ” Practice Location

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