| Bizban Llc | |
|
1162 E Sonterra Blvd Suite 130 San Antonio TX 78258-4047 | |
| (210) 643-4393 | |
| (210) 408-1096 |
| Full Name | Bizban Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1162 E Sonterra Blvd, San Antonio, Texas |
| Authorized Official Name and Position | Laurie A Bizzell (PSYCHOLOGIST) |
| Authorized Official Contact | 2106434393 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bizban Llc 1162 E Sonterra Blvd Suite 130 San Antonio TX 78258-4047 Ph: (210) 643-4393 | Bizban Llc 1162 E Sonterra Blvd Suite 130 San Antonio TX 78258-4047 Ph: (210) 643-4393 |
| NPI Number | 1932582913 |
|---|---|
| Provider Enumeration Date | 07/08/2015 |
| Last Update Date | 07/08/2015 |
| Medicare PECOS PAC ID | 5698084960 |
|---|---|
| Medicare Enrollment ID | O20151028000396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932582913 | NPI | - | NPPES |
| 30855 | Other | TX | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 30855 (Texas) | Primary |
| Provider Name | Laurie A Bizzell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740681121 PECOS PAC ID: 0143547315 Enrollment ID: I20150327000292 |
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