Provider Information for 1003663816
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LAURIE RENEE SPEED
Sex: Female
NPI: 1003663816
Last Updated: 2024-05-29
Certification Date: 2024-05-29
Certification Date: 2024-05-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1003663816 | ||||||||
| Enumeration Date | 2024-05-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8627 CINNAMON CREEK DR BLDG 401 SAN ANTONIO, TX 78240-1482 United States Phone: 210-549-6663 | Fax:210-610-8291 | ||||||||
| Primary Practice Address | 8627 CINNAMON CREEK DR BLDG 401 SAN ANTONIO, TX 78240-1482 United States Phone: 210-549-6663 | Fax:210-610-8291 | ||||||||
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