Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | J9397 | TX |
NPI | 1093809428 |
---|---|
Provider Name | Dr. Sara Maria Conde |
First Address | San Antonio, TX 78229-3307 |
Second Address | San Antonio, TX 78229-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 27/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83020V | BLUE CROSS AND BLUE SHIEL (01) | TX |
VAD000 | (02) | TX |