Individual
DR. LUIS OMAR VALDIVIESO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
2100 BERQGUIRE RD STE NO. 1, SAN ANTONIO, TX 78236
(210) 292-2453
Mailing address
13116 MYSTIC SADDLE, HELOTES, TX 78023-3985
Taxonomy
Speciality
Code
Description
License number
State
1835N1003X
Nutrition Support Pharmacist
Primary
42791
TX
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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