Provider Demographics
NPI:1326580408
Name:TEXAS DERM INSTITUTE, PA
Entity Type:Organization
Organization Name:TEXAS DERM INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:AREFNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-494-3376
Mailing Address - Street 1:24165 W IH 10
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1114
Mailing Address - Country:US
Mailing Address - Phone:830-494-3376
Mailing Address - Fax:844-819-1872
Practice Address - Street 1:24165 W IH 10
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1114
Practice Address - Country:US
Practice Address - Phone:830-494-3376
Practice Address - Fax:844-819-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN006261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty