Basic Information
| Provider Information | |||||||||
| NPI: | 1255451779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULOTTA | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6243 IH 10 W | ||||||||
| Address2: | STE 480 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782012086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107314800 | ||||||||
| FaxNumber: | 2107314810 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 N GENERAL MCMULLEN DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782286205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102490212 | ||||||||
| FaxNumber: | 2102490217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 03/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F-5507 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.