Provider Demographics
NPI:1194916890
Name:SAN ANTONIO COSMETIC SURGERY, PA
Entity type:Organization
Organization Name:SAN ANTONIO COSMETIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:ORTEGON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-4320
Mailing Address - Street 1:11212 STATE HIGHWAY 151
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4499
Mailing Address - Country:US
Mailing Address - Phone:210-614-4320
Mailing Address - Fax:210-614-4302
Practice Address - Street 1:11212 STATE HIGHWAY 151
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4499
Practice Address - Country:US
Practice Address - Phone:210-614-4320
Practice Address - Fax:210-614-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty