Basic Information
Provider Information
NPI: 1033556857
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SARAVIA
FirstName: PATRICIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1715 MCCULLOUGH AVE
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782124046
CountryCode: US
TelephoneNumber: 2102255323
FaxNumber: 2102257505
Practice Location
Address1: 1715 MCCULLOUGH AVE
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782124046
CountryCode: US
TelephoneNumber: 2102255323
FaxNumber: 2102257505
Other Information
ProviderEnumerationDate: 06/03/2013
LastUpdateDate: 10/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XQ9024TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
519336YLPS01TXWELLMED MEDICAREOTHER


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