Provider Demographics
NPI:1174090518
Name:TESORO HOME VISITS LLC
Entity type:Organization
Organization Name:TESORO HOME VISITS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJA SWAROOP
Authorized Official - Middle Name:
Authorized Official - Last Name:YARLAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-718-4445
Mailing Address - Street 1:18235 BULVERDE RD STE 105-27
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18235 BULVERDE RD STE 105-27
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3765
Practice Address - Country:US
Practice Address - Phone:210-718-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherIN PROCESS AND WAITING