MEDICARE: SAN ANTONIO MONITORING

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1891009932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO MONITORING

Provider Business Mailing Address
First Line	:	6338 N NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6338 N NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3826
Country	:	US
Telephone Number	:	210-854-9488
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SCOTT LAROQUE I
Credential	:
Telephone Number	:	210-854-9488

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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Directions to “SAN ANTONIO MONITORING ” Practice Location

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