| NPI | 1326913484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNA LAROQUE Director, Client Relations 210-598-4262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2025-10-08 |
| Last Update Date | 2025-10-08 |