Provider Demographics
NPI:1003166752
Name:OSCAR SAN MIGUEL JR MED-PRO
Entity Type:Organization
Organization Name:OSCAR SAN MIGUEL JR MED-PRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN MIGUEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-313-8093
Mailing Address - Street 1:404 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4408
Mailing Address - Country:US
Mailing Address - Phone:830-313-8093
Mailing Address - Fax:
Practice Address - Street 1:404 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4408
Practice Address - Country:US
Practice Address - Phone:830-313-8093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies