Individual
FABIAN LEON BEDOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9216 DUBLIN GRN, SAN ANTONIO, TX 78254-5432
(210) 792-9942
Mailing address
9216 DUBLIN GRN, SAN ANTONIO, TX 78254-5432
(210) 792-9942
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
38935
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14799577
DRIVER LICENSE
TX
Enumeration date
07/23/2021
Last updated
07/23/2021
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