Provider Demographics
NPI:1306503446
Name:KLARISANA PHYSICIAN SERVICES PLLC
Entity type:Organization
Organization Name:KLARISANA PHYSICIAN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-556-1430
Mailing Address - Street 1:8600 WURZBACH RD STE 1110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4334
Mailing Address - Country:US
Mailing Address - Phone:210-556-1430
Mailing Address - Fax:888-504-2390
Practice Address - Street 1:916 S MAIN ST UNIT 208
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6617
Practice Address - Country:US
Practice Address - Phone:210-556-1430
Practice Address - Fax:888-504-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty