Provider Demographics
NPI:1275545519
Name:PSYCHIATRIC ASSOCIATES OF SAN ANTONIO
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMASO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-225-3764
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-225-3764
Mailing Address - Fax:210-226-7153
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-225-3764
Practice Address - Fax:210-226-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD55632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F38YMedicare ID - Type UnspecifiedGROUP NUMBER