1144764903 NPI number — SARAI LEEB HERMAN PC

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 1144764903 NPI number — SARAI LEEB HERMAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARAI LEEB HERMAN PC
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:
6
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:
1144764903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 CLUB DR
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:
78201-3714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-272-3513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11107 WURZBACH RD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-428-5302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEEB-HERMAN
Authorized Official First Name:
SARAI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER THERAPIST
Authorized Official Telephone Number:
480-272-3513

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  52900 , 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)