| NPI | 1902398365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE A. FLORES Billing Supervisor 210-890-1508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2020-01-30 |