Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2015-06-17
- Last updated
- 2015-06-17
Specialties
Licenses
- License TX
- 112383
Location
- Practice location
- 9518 TASCATE DR
- City
- HELOTES TX
- Postal code
- 780234153
- Phone
- 210-519-1404
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.