1285884759 NPI number — VIVIAN W BUCAY MD PLLC

Table of content: (NPI 1285884759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285884759 NPI number — VIVIAN W BUCAY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIVIAN W BUCAY MD PLLC
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:
1285884759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 W CRAIG PL
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:
78212-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-692-3000
Provider Business Mailing Address Fax Number:
210-692-3056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 W CRAIG PL
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:
78212-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-3000
Provider Business Practice Location Address Fax Number:
210-692-3056
Provider Enumeration Date:
09/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREEHAUF
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
830-931-5582

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  H3955 , 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)