Provider Demographics
NPI:1801391768
Name:NEUROVEDA, PLLC
Entity Type:Organization
Organization Name:NEUROVEDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING CO-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WAE
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-686-5000
Mailing Address - Street 1:4402 VANCE JACKSON RD STE 248
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5334
Mailing Address - Country:US
Mailing Address - Phone:210-686-5000
Mailing Address - Fax:210-239-5060
Practice Address - Street 1:4402 VANCE JACKSON RD STE 248
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5334
Practice Address - Country:US
Practice Address - Phone:210-686-5000
Practice Address - Fax:210-239-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty