Spa, Pllc | |
3740 Colony Dr Ste 122 San Antonio TX 78230-2290 | |
(210) 416-4238 | |
Not Available |
Full Name | Spa, Pllc |
---|---|
Speciality | Counselor |
Location | 3740 Colony Dr Ste 122, San Antonio, Texas |
Authorized Official Name and Position | Rene Lucio (ADMINISTRATOR) |
Authorized Official Contact | 9562156735 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Spa, Pllc 5434 Timber Trace St San Antonio TX 78250-4442 Ph: (956) 215-6735 | Spa, Pllc 3740 Colony Dr Ste 122 San Antonio TX 78230-2290 Ph: (210) 416-4238 |
NPI Number | 1144836412 |
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Provider Enumeration Date | 09/21/2020 |
Last Update Date | 07/27/2023 |
Certification Date | 07/27/2023 |
Medicare PECOS PAC ID | 5597103838 |
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Medicare Enrollment ID | O20240404003080 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144836412 | NPI | - | NPPES |
Provider Name | Claudia I Castaneda |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1689130668 PECOS PAC ID: 0547609166 Enrollment ID: I20240417002578 |
Provider Name | Ramon A Gonzales |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1467832287 PECOS PAC ID: 4880972413 Enrollment ID: I20240503002042 |
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