1487971867 NPI number — APSLEY MEDICAL GROUP, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487971867 NPI number — APSLEY MEDICAL GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APSLEY MEDICAL GROUP, 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:
DEZAVALA FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1487971867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4435 DEZAVALA
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:
78249-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-694-4081
Provider Business Mailing Address Fax Number:
210-696-8053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4435 DEZAVALA
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:
78249-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-694-4081
Provider Business Practice Location Address Fax Number:
210-696-8053
Provider Enumeration Date:
04/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
APSLEY AMBRIZ
Authorized Official First Name:
SARA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-694-4081

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G4792 , 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)

  • Identifier: 2158131-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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