Provider Demographics
NPI:1255367439
Name:SAN PEDRO HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SAN PEDRO HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-731-4105
Mailing Address - Street 1:4202 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1864
Mailing Address - Country:US
Mailing Address - Phone:210-731-4105
Mailing Address - Fax:210-731-4123
Practice Address - Street 1:4202 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1864
Practice Address - Country:US
Practice Address - Phone:210-731-4105
Practice Address - Fax:210-731-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health