Organization
VATANADILOK ENTERPRISE LLC
Active
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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