| Longevity Clinical Ltc Associates Of Texas, Pllc | |
|
8000 W Ih 10 Ste 600 San Antonio TX 78230-3887 | |
| (561) 815-2427 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of Texas, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 8000 W Ih 10 Ste 600, San Antonio, Texas |
| Authorized Official Name and Position | Diane Vincur (LWC PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of Texas, Pllc 11780 Us Highway 1 Ste N107 North Palm Beach FL 33408-3007 Ph: () - | Longevity Clinical Ltc Associates Of Texas, Pllc 8000 W Ih 10 Ste 600 San Antonio TX 78230-3887 Ph: (561) 815-2427 |
| NPI Number | 1720769698 |
|---|---|
| Provider Enumeration Date | 07/25/2023 |
| Last Update Date | 07/25/2023 |
| Medicare PECOS PAC ID | 5597119073 |
|---|---|
| Medicare Enrollment ID | O20231003000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720769698 | NPI | - | NPPES |
| Provider Name | Anita Sherali |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700395001 PECOS PAC ID: 0143587469 Enrollment ID: I20171121003390 |
| Provider Name | Waseem Ghannam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306080510 PECOS PAC ID: 5092971085 Enrollment ID: I20220428002256 |
| Provider Name | Noemi Gabriela Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487210803 PECOS PAC ID: 5496103905 Enrollment ID: I20231122000487 |
| Provider Name | Olufemi Fanusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003561705 PECOS PAC ID: 4284015215 Enrollment ID: I20240605000964 |
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