Organization
CRYSTAL WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE MACK (OWNER)
(210) 802-4695
Entity
Organization
Contact information
Practice address
6609 BLANCO RD STE 335, SAN ANTONIO, TX 78216-4504
(210) 455-1779
(210) 802-4698
Mailing address
116 GALLERY CIR STE 201, SAN ANTONIO, TX 78258-3341
(210) 802-4695
(210) 802-4698
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
08/19/2024
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