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Individual

JACK STEVEN DANIELS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LVN

Contact information

Practice address
241 SEFORD DR, SAN ANTONIO, TX 78209-6036
(210) 965-8719
Mailing address
241 SEFORD DR, SAN ANTONIO, TX 78209-6036
(210) 965-8719

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
129387
TX
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
129387
TX

Other

Enumeration date
05/05/2023
Last updated
05/05/2023
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