Individual
TIM SENTHAVISOUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4800 FREDERICKSBURG RD, SUITE 127, SAN ANTONIO, TX 78229-3628
(210) 733-5072
(210) 733-8649
Mailing address
PO BOX 1239, TROY, MI 48099-1239
(248) 824-6600
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
775309
TX
363LF0000X
Family Nurse Practitioner
775309
TX
363LF0000X
Family Nurse Practitioner
NP 16316
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0930196740
—
CA
Enumeration date
10/09/2007
Last updated
05/05/2014
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