| NPI | 1205675121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW THOMAS VIDAL Owner 210-844-7550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-05-21 |