Individual
TANPRASERTH VATANADILOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
6157 NW LOOP 410, STE. 124, SAN ANTONIO, TX 78238-3302
(210) 681-4777
(210) 681-1887
Mailing address
6157 NW LOOP 410, STE. 124, SAN ANTONIO, TX 78238-3302
(210) 681-4777
(210) 681-1887
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
611125
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170306808
WELLMED MEDICAID
TX
01
—
TXB158725
WELLMED MEDICARE
TX
Enumeration date
07/08/2006
Last updated
10/18/2016
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