# FIESTA IMAGING, LP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750040028
- **Authorized official:** MR. KENNETH LAN (ADMINISTRATOR)
- **Authorized official phone:** (210) 299-7600

## Contact information

- **Practice address:** 8706 FREDERICKSBURG RD STE 103, SAN ANTONIO, TX 78240-1293
- **Practice address phone:** (210) 299-7600
- **Practice address fax:** (210) 299-7610
- **Mailing address:** 8706 FREDERICKSBURG RD STE 103, SAN ANTONIO, TX 78240-1293
- **Mailing address phone:** (210) 299-7600
- **Mailing address fax:** (210) 299-7610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2021
- **Last updated:** 12/16/2022