| NPI | 1124247119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LONGORIA Credentialing Specialist 210-268-0129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J5738) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2021-04-01 |