1699173435 NPI number — San Antonio Pediatrics : sapediatric.com Angelica M Pentecost N.P.

Table of content: Angelica M Pentecost N.P. (NPI 1699173435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699173435 NPI number — San Antonio Pediatrics : sapediatric.com Angelica M Pentecost N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
San Antonio Pediatrics : sapediatric.com
Provider Last Name:
Pentecost
Provider First Name:
Angelica
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

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:
1699173435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 North San Saba Street #1075
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:
78207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-223-3543
Provider Business Mailing Address Fax Number:
210-227-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 Buena Vista Street
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:
78207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-223-3543
Provider Business Practice Location Address Fax Number:
210-227-0282
Provider Enumeration Date:
12/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP126307 , 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 © 2007-2025 www.npivalidator.com