Provider Demographics
NPI:1326230160
Name:PAIN & RECOVERY CLINIC OF SAN ANTONIO
Entity Type:Organization
Organization Name:PAIN & RECOVERY CLINIC OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CUSTODIAN OF RECORDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-299-1444
Mailing Address - Street 1:6851 CITIZENS PKWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3620
Mailing Address - Country:US
Mailing Address - Phone:210-299-1444
Mailing Address - Fax:210-299-1446
Practice Address - Street 1:6851 CITIZENS PKWY
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3620
Practice Address - Country:US
Practice Address - Phone:210-299-1444
Practice Address - Fax:210-299-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8690261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation