Individual
PORFIRIA PEARL WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8515 GLENBLUFF, SAN ANTONIO, TX 78239
(210) 654-1165
(210) 654-1178
Mailing address
PO BOX 39102, SAN ANTONIO, TX 78218-1102
(210) 654-1165
(210) 654-1178
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0103368012
—
TX
Enumeration date
10/11/2006
Last updated
07/08/2007
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