Provider Demographics
NPI:1003165085
Name:SANO, MICHAEL ANGEL (COO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGEL
Last Name:SANO
Suffix:
Gender:M
Credentials:COO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1450
Mailing Address - Country:US
Mailing Address - Phone:210-267-2199
Mailing Address - Fax:210-267-2199
Practice Address - Street 1:515 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1925
Practice Address - Country:US
Practice Address - Phone:210-267-2199
Practice Address - Fax:210-267-2199
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation