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NPI Code Detail

MEDICARE: TANPRASERTH VATANADILOK N.P.

MEDICARE: TANPRASERTH VATANADILOK N.P.
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
1363L00000XNurse Practitioner611125TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2TXB158725OTHERTXWELLMED MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326071838
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANPRASERTH VATANADILOK N.P.
Provider Business Mailing Address
First Line : 6157 NW LOOP 410
Second Line : STE. 124
City : SAN ANTONIO
State : TX
Zip : 78238-3302
Country : US
Telephone Number : 210-681-4777
Fax Number : 210-681-1887
Provider Business Practice Location Address
First Line : 6157 NW LOOP 410
Second Line : STE. 124
City : SAN ANTONIO
State : TX
Zip : 78238-3302
Country : US
Telephone Number : 210-681-4777
Fax Number : 210-681-1887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 10/18/2016

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Directions to “ TANPRASERTH VATANADILOK N.P.” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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