Individual
MR. ISRAEL D. CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4805 FREDERICKSBURG RD, SAN ANTONIO, TX 78229-3627
(210) 979-7999
(210) 798-2457
Mailing address
4805 FREDERICKSBURG RD, SAN ANTONIO, TX 78229-3627
(210) 979-7999
(210) 798-2457
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01549
TX
Other
Enumeration date
03/02/2007
Last updated
07/08/2007
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