Provider Demographics
NPI:1689243156
Name:CONCUSSIVE AND COGNITIVE DIAGNOSTICS PLLC
Entity Type:Organization
Organization Name:CONCUSSIVE AND COGNITIVE DIAGNOSTICS PLLC
Other - Org Name:ALTA VITA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MS
Authorized Official - First Name:LAIDEE
Authorized Official - Middle Name:HANIKA
Authorized Official - Last Name:FRANCIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:210-332-9100
Mailing Address - Street 1:10218 DESERT SANDS ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3910
Mailing Address - Country:US
Mailing Address - Phone:210-341-1012
Mailing Address - Fax:210-349-7876
Practice Address - Street 1:10300 HERITAGE ST STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3924
Practice Address - Country:US
Practice Address - Phone:210-441-2557
Practice Address - Fax:210-349-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty