Organization · NPI-2

Dermatology Specialists Of San Antonio, PLLC

Dermatology · San Antonio, TX

NPI number1275925869

StatusActive

Last updated in NPPESApr 19, 2022

Details

NPI: 1275925869
Entity type: Organization (NPI-2)
Legal business name: Dermatology Specialists Of San Antonio, PLLC
Organization subpart: No
Enumeration date: Feb 19, 2015
Certification date: Apr 19, 2022
Last updated: Apr 19, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207N00000X	Dermatology	–	–	Yes
207ND0101X	Dermatology, MOHS-Micrographic Surgery	–	–
207ZD0900X	Pathology, Dermatopathology	–	–

Practice location

2520 Broadway St Ste 202
San Antonio, TX 78215-1149

Phone 210-541-4884 · Fax 210-541-4900

Mailing address

4919 Memorial Hwy Ste 150
Tampa, FL 33634-7516

Phone 813-333-1512 · Fax 813-333-1561

Authorized official

Nicole Marie Owens
Managing Owner
2105414884

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