Basic Information
| Provider Information | |||||||||
| NPI: | 1689017923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAPPAS | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | ILEAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7330 SAN PEDRO AVE., SUITE 540 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 MCCULLOUGH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524556799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 06/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R0092 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.