Provider Demographics
NPI:1295984870
Name:MYWTLOSSSURGEON ASSOCIATES
Entity type:Organization
Organization Name:MYWTLOSSSURGEON ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAJAJOSHIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-324-5726
Mailing Address - Street 1:22 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1019
Mailing Address - Country:US
Mailing Address - Phone:210-579-0737
Mailing Address - Fax:
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:STE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-324-5726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty