Basic Information
| Provider Information | |||||||||
| NPI: | 1255318473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | AUNDRE' | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | COTA-L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1904 GRANDSTAND DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782384508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105208070 | ||||||||
| FaxNumber: | 2105217688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1904 GRANDSTAND DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782384508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105208070 | ||||||||
| FaxNumber: | 2105217688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 209498 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.