Organization
VATANADILOK ENTERPRISE LLC
Active
Other names
Geriatric and Palliative Focus
Organization subpart
No
Provider details
NPI number
Authorized official
TANPRASERTH VATANADILOK N.P. (NURSE PRACTITIONER)
(972) 687-9138
Entity
Organization
Contact information
Practice address
4879 CORIAN SPRINGS DR, SAN ANTONIO, TX 78247-5599
(210) 379-7340
Mailing address
4879 CORIAN SPRINGS DR, SAN ANTONIO, TX 78247-5599
(210) 379-7340
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
H3885
TX
363LF0000X
Family Nurse Practitioner
611125
TX
Other
Enumeration date
03/15/2016
Last updated
03/15/2016
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