Provider Demographics
NPI:1497203764
Name:AVESTEE WOMEN'S IMAGING CENTER OF BOERNE, PLLC
Entity Type:Organization
Organization Name:AVESTEE WOMEN'S IMAGING CENTER OF BOERNE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DABBOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-826-2666
Mailing Address - Street 1:303 W SUNSET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1749
Mailing Address - Country:US
Mailing Address - Phone:210-826-2666
Mailing Address - Fax:
Practice Address - Street 1:112 HERFF RD STE 350
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2752
Practice Address - Country:US
Practice Address - Phone:210-826-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty