MEDICARE: RICARDO VIESCA JR. CPHT

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
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1689302234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO VIESCA JR. CPHT

Provider Business Mailing Address
First Line	:	3503 FREDERICKSBURG RD STE 450
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3969
Country	:	US
Telephone Number	:	877-432-9355
Fax Number	:	866-466-0104

Provider Business Practice Location Address
First Line	:	3503 FREDERICKSBURG RD STE 450
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3969
Country	:	US
Telephone Number	:	877-432-9355
Fax Number	:	866-466-0104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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