1205067907 NPI number — WENDY BACA M.D.P.A.

Table of content: (NPI 1205067907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205067907 NPI number — WENDY BACA M.D.P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDY BACA M.D.P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205067907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78265-5165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-379-9600
Provider Business Mailing Address Fax Number:
830-303-5033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7049 SAN PEDRO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-6209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-342-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BACA
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-380-7968

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  K4359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)