Provider Demographics
NPI:1720342454
Name:PERSONALIZED PRESCRIPTION PHYSICIANS, LLC
Entity Type:Organization
Organization Name:PERSONALIZED PRESCRIPTION PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EWESUEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-625-1171
Mailing Address - Street 1:PO BOX 40116
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1116
Mailing Address - Country:US
Mailing Address - Phone:210-253-9947
Mailing Address - Fax:
Practice Address - Street 1:7800 IH 10 WEST
Practice Address - Street 2:SUITE 612
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-253-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2069208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical PharmacologyGroup - Single Specialty