Provider Demographics
NPI:1992043814
Name:SAN ANTONIO OPERATIVE MONITORING, LLC
Entity type:Organization
Organization Name:SAN ANTONIO OPERATIVE MONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVALA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:210-255-8935
Mailing Address - Street 1:4423 NW LOOP 410
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5145
Mailing Address - Country:US
Mailing Address - Phone:210-255-8935
Mailing Address - Fax:210-255-8026
Practice Address - Street 1:4423 NW LOOP 410
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5145
Practice Address - Country:US
Practice Address - Phone:210-255-8935
Practice Address - Fax:210-255-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9760207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty