Provider Demographics
NPI:1366841280
Name:THE UNIVERSITY OF TEXAS AT SAN ANTONIO
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS AT SAN ANTONIO
Other - Org Name:UTSA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-458-4111
Mailing Address - Street 1:1 UTSA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1644
Mailing Address - Country:US
Mailing Address - Phone:210-458-5969
Mailing Address - Fax:210-458-7281
Practice Address - Street 1:501 W CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4415
Practice Address - Country:US
Practice Address - Phone:210-458-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health