1689243156 NPI number — CONCUSSIVE AND COGNITIVE DIAGNOSTICS PLLC

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 1689243156 NPI number — CONCUSSIVE AND COGNITIVE DIAGNOSTICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCUSSIVE AND COGNITIVE DIAGNOSTICS 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:
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:
1689243156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10218 DESERT SANDS ST APT 5A
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:
78216-3910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-341-1012
Provider Business Mailing Address Fax Number:
210-349-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 HERITAGE ST STE 140
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:
78216-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-441-2557
Provider Business Practice Location Address Fax Number:
210-349-7876
Provider Enumeration Date:
06/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCIA
Authorized Official First Name:
LAIDEE
Authorized Official Middle Name:
HANIKA
Authorized Official Title or Position:
OWNER/NP
Authorized Official Telephone Number:
210-332-9100

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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