Provider Demographics
NPI:1427470517
Name:LEV DE LEI PROMOTIONAL ALLIANCE LLC
Entity type:Organization
Organization Name:LEV DE LEI PROMOTIONAL ALLIANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:OMBABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-370-9710
Mailing Address - Street 1:20079 STONE OAK PKWY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20079 STONE OAK PKWY
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6942
Practice Address - Country:US
Practice Address - Phone:210-370-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty