| NPI | 1518268747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA R PACHECO Billing/Credentialling 210-615-1406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX G5032) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2015-08-11 |