Provider Demographics
NPI:1053344143
Name:SAN ANTONIO PODIATRY ASSOCIATES PLLC
Entity type:Organization
Organization Name:SAN ANTONIO PODIATRY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-899-1026
Mailing Address - Street 1:12450 NETWORK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3466
Mailing Address - Country:US
Mailing Address - Phone:210-899-1026
Mailing Address - Fax:210-314-3632
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:450
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-692-0279
Practice Address - Fax:210-692-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LK67Medicare UPIN
TX00LK67Medicare ID - Type UnspecifiedMEDICARE PROVIDER