Basic Information
| Provider Information | |||||||||
| NPI: | 1922401033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACOB CHRISTOPHER CARUSO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12106 STONEY POND | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782474939 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 INWOOD RD | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146453300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2014 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | CARUSO | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 2567148656 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP126421 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.