Provider Demographics
NPI:1073997789
Name:GEORGE, SANDRA (DO, PA-C, RD, LD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DO, PA-C, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 CHRISTUS HILLS
Mailing Address - Street 2:MEDICAL PLAZA 3, 3RD FLOOR
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3585
Mailing Address - Country:US
Mailing Address - Phone:210-703-9001
Mailing Address - Fax:210-703-9155
Practice Address - Street 1:11130 CHRISTUS HILLS
Practice Address - Street 2:MEDICAL PLAZA 3, 3RD FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3585
Practice Address - Country:US
Practice Address - Phone:210-703-9001
Practice Address - Fax:210-703-9155
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83790133V00000X
TXPA10160363A00000X
NY018749-1363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant