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NPI Code Detail

MEDICARE: BESSY M MOONNUMACKAL NP-C

MEDICARE: BESSY M MOONNUMACKAL NP-C
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 PractitionerAP129068TX

General Provider Information

NPI Number : 1417313180
Entity Type Code : Individual
Provider Name (Legal Business Name) : BESSY M MOONNUMACKAL NP-C
Provider Business Mailing Address
First Line : 8527 VILLAGE DR STE 205
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78217-5507
Country : US
Telephone Number : 210-946-5633
Fax Number : 210-946-5632
Provider Business Practice Location Address
First Line : 2515 CASTROVILLE RD STE 1
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78237-3361
Country : US
Telephone Number : 210-946-5633
Fax Number : 210-946-5632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2016
Last Update Date : 01/11/2016

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