Individual
BONGSUN RICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4411 MEDICAL DR, SAN ANTONIO, TX 78229-3822
(210) 614-5400
Mailing address
4411 MEDICAL DR STE 300, SAN ANTONIO, TX 78229-3824
(210) 614-5400
(210) 614-4244
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP138817
TX
363LF0000X
Family Nurse Practitioner
AP138817
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814744
MEDICARE PTAN
TX
Enumeration date
09/14/2018
Last updated
02/11/2022
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