Individual
DIVINA G BUCCELLATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3070 COLORADO CV, SAN ANTONIO, TX 78253-6294
(203) 228-8485
Mailing address
3040 COLORADO COVE, SAN ANTONIO, TX 78253
(203) 228-8485
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
141736
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
141736
TX
Other
Enumeration date
06/27/2019
Last updated
12/19/2023
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