Organization
INTERVENTIONAL PAIN MANAGEMENT PHYSICIANS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE LONGORIA (CREDENTIALING SPECIALIST)
(210) 268-0129
Entity
Organization
Contact information
Practice address
110 STONE OAK LOOP, SUITE 103, SAN ANTONIO, TX 78258-3511
(210) 268-0129
(210) 497-8333
Mailing address
19141 STONE OAK PKWY STE 104, SAN ANTONIO, TX 78258-3367
(210) 268-0129
(210) 314-4609
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J5738
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080538401
—
TX
Enumeration date
04/25/2007
Last updated
04/01/2021
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