Provider Demographics
NPI:1992367155
Name:SAN ANTONIO FAMILY PSYCHIATRY
Entity Type:Organization
Organization Name:SAN ANTONIO FAMILY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-550-3712
Mailing Address - Street 1:16007 VIA SHAVANO STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2359
Mailing Address - Country:US
Mailing Address - Phone:210-492-1666
Mailing Address - Fax:210-615-9400
Practice Address - Street 1:16007 VIA SHAVANO STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2359
Practice Address - Country:US
Practice Address - Phone:210-492-1666
Practice Address - Fax:210-615-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty