Individual
IVAN LIONEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
2643 CONCAN ST, SAN ANTONIO, TX 78251-1714
(512) 689-8273
Mailing address
2643 CONCAN ST, SAN ANTONIO, TX 78251-1714
(512) 689-8273
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT2442
TX
Other
Enumeration date
02/15/2022
Last updated
02/15/2022
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