Provider Demographics
NPI:1023769387
Name:SOUTH AUSTIN ENDOCRINOLOGY AND OBESITY CLINIC PLLC
Entity type:Organization
Organization Name:SOUTH AUSTIN ENDOCRINOLOGY AND OBESITY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-742-0081
Mailing Address - Street 1:1340 WONDER WORLD DR STE 2203
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7791
Mailing Address - Country:US
Mailing Address - Phone:512-969-8991
Mailing Address - Fax:512-982-6186
Practice Address - Street 1:1340 WONDER WORLD DR STE 2203
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7791
Practice Address - Country:US
Practice Address - Phone:512-969-8991
Practice Address - Fax:512-982-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty