Individual
DERRICK ANTHONY HEAGGANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7330 SAN PEDRO AVE, SAN ANTONIO, TX 78216-6235
(210) 857-3579
Mailing address
1518 OAKCASK, SAN ANTONIO, TX 78253-6031
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
203741
TX
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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