Provider Demographics
NPI:1619849676
Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity type:Organization
Organization Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR, MED STAFF SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-450-4736
Mailing Address - Street 1:8431 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3392
Mailing Address - Country:US
Mailing Address - Phone:210-450-4621
Mailing Address - Fax:210-450-4903
Practice Address - Street 1:903 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-0903
Practice Address - Country:US
Practice Address - Phone:210-358-3985
Practice Address - Fax:210-358-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty