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NPI Code Detail

MEDICARE: LARINA V GUTENBERG DO PLLC

MEDICARE: LARINA V GUTENBERG DO 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
1207LP2900XPain Medicine (Anesthesiology) PhysicianTX

General Provider Information

NPI Number : 1710253646
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARINA V GUTENBERG DO PLLC
Provider Business Mailing Address
First Line : 5522 LONE STAR PKWY BLDG 2
Second Line : STE 101
City : SAN ANTONIO
State : TX
Zip : 78253-6720
Country : US
Telephone Number : 210-298-4900
Fax Number : 210-298-6631
Provider Business Practice Location Address
First Line : 5522 LONE STAR PKWY BLDG 2
Second Line : STE 101
City : SAN ANTONIO
State : TX
Zip : 78253-6720
Country : US
Telephone Number : 210-298-4900
Fax Number : 210-298-6631
Authorized Official
Title or Position : ADMINISTRATOR
Name : ALEKSEI GUTENBERG
Credential :
Telephone Number : 210-298-4900
Provider Enumeration Date : 03/26/2012
Last Update Date : 02/23/2024

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