Provider Demographics
NPI:1790935922
Name:TEXAS EVALUATION CENTER OF SAN ANTONIO
Entity Type:Organization
Organization Name:TEXAS EVALUATION CENTER OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TEXAS EVALUATION CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-657-2328
Mailing Address - Street 1:4414 CENTER GATE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4806
Mailing Address - Country:US
Mailing Address - Phone:210-657-2328
Mailing Address - Fax:210-657-2492
Practice Address - Street 1:4414 CENTER GATE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4806
Practice Address - Country:US
Practice Address - Phone:210-657-2328
Practice Address - Fax:210-657-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty