Provider Demographics
NPI:1811419880
Name:TRUSTED CARE SAN ANTONIO NW LLC
Entity Type:Organization
Organization Name:TRUSTED CARE SAN ANTONIO NW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-715-1654
Mailing Address - Street 1:20430 N 19TH AVE STE B145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3588
Mailing Address - Country:US
Mailing Address - Phone:210-202-0288
Mailing Address - Fax:
Practice Address - Street 1:2116 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4411
Practice Address - Country:US
Practice Address - Phone:602-715-1654
Practice Address - Fax:602-715-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical