Provider Demographics
NPI:1134685480
Name:CONNOISSEUR HEALTH PROS, LLC
Entity Type:Organization
Organization Name:CONNOISSEUR HEALTH PROS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:DARIEL
Authorized Official - Last Name:VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-968-3050
Mailing Address - Street 1:1615 S. VETERANS BLVD.
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:830-968-3050
Mailing Address - Fax:866-571-0395
Practice Address - Street 1:1615 S. VETERANS BLVD.
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-968-3050
Practice Address - Fax:866-571-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty