| NPI | 1639508799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABRICIO TEIXEIRA Program Director 210-567-3381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ZZ 97643) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |