Provider Demographics
NPI:1851694194
Name:GRUNBERG, WENDIE IRIS (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDIE
Middle Name:IRIS
Last Name:GRUNBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 W SUNSET RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1771
Mailing Address - Country:US
Mailing Address - Phone:210-714-5390
Mailing Address - Fax:210-495-4114
Practice Address - Street 1:414 W SUNSET RD STE 215
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1771
Practice Address - Country:US
Practice Address - Phone:210-714-5390
Practice Address - Fax:210-495-4114
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012444208600000X
TXQ64222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery