1730448937 NPI number — SAN ANTONIO COMPREHENSIVE CARE OB/GYN

Table of content: (NPI 1730448937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730448937 NPI number — SAN ANTONIO COMPREHENSIVE CARE OB/GYN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO COMPREHENSIVE CARE OB/GYN
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:
1730448937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7003 S. NEW BRAUNFELS AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-333-4700
Provider Business Mailing Address Fax Number:
210-579-1685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7003 S. NEW BRAUNFELS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-333-4700
Provider Business Practice Location Address Fax Number:
210-579-1685
Provider Enumeration Date:
05/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DANDAN
Authorized Official First Name:
MELHEM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-333-4700

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A78213 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: P0716 , 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)





Copyright © 2007-2024 www.npivalidator.com