Provider Demographics
NPI:1215584644
Name:BOCANGEL INTEGRATIVE MEDICINE & ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:BOCANGEL INTEGRATIVE MEDICINE & ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA BOCANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:512-809-5430
Mailing Address - Street 1:100 LORENZ RD APT 404
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7122 SAN PEDRO AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6233
Practice Address - Country:US
Practice Address - Phone:210-967-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty