Individual
ANDY RAUL MANZANO MATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
11329 WEST AVE, SAN ANTONIO, TX 78213-1341
(210) 886-8666
(210) 886-8667
Mailing address
11329 WEST AVE, SAN ANTONIO, TX 78213-1341
(210) 886-8666
(210) 886-8667
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1551
PR
Other
Enumeration date
03/27/2023
Last updated
04/25/2023
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