Individual
IME MBANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
234 CONWAY DR, SAN ANTONIO, TX 78209-1716
(210) 612-8318
Mailing address
3711 MEDICAL DR APT 1527, SAN ANTONIO, TX 78229-2289
(210) 612-8318
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
308469
TX
Other
Enumeration date
08/05/2018
Last updated
08/05/2018
About Stedi
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