Individual
MR. JOHNNY RAY LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
5507 ROYAL VISTA DR, SAN ANTONIO, TX 78247-4669
(210) 650-4794
Mailing address
5507 ROYAL VISTA DR, SAN ANTONIO, TX 78247-4669
(210) 650-4794
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
157145
TX
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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