Provider Demographics
NPI:1134642515
Name:WENDIE I. GRUNBERG, DO, PLLC
Entity Type:Organization
Organization Name:WENDIE I. GRUNBERG, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-360-2594
Mailing Address - Street 1:414 W SUNSET RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1771
Mailing Address - Country:US
Mailing Address - Phone:210-714-5390
Mailing Address - Fax:210-495-4114
Practice Address - Street 1:414 W SUNSET RD STE 215
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1771
Practice Address - Country:US
Practice Address - Phone:210-714-5390
Practice Address - Fax:210-495-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty