Individual
ANDITA DWI HIDAYATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 450-9100
Mailing address
145 CHAPEL HILL CIR, SAN ANTONIO, TX 78240-3977
(210) 978-4285
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
BP10087321
TX
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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