Basic Information
Provider Information
NPI: 1871540393
EntityType: 2
ReplacementNPI:  
OrganizationName: CUERO LAKEVIEW KIDNEY CENTER LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 315 N SAN SABA
Address2: STE,101
City: SAN ANTONIO
State: TX
PostalCode: 782073154
CountryCode: US
TelephoneNumber: 2107981955
FaxNumber: 2107985424
Practice Location
Address1: 315 N SAN SABA
Address2: STE,101
City: SAN ANTONIO
State: TX
PostalCode: 782073154
CountryCode: US
TelephoneNumber: 2107981955
FaxNumber: 2107985424
Other Information
ProviderEnumerationDate: 05/29/2006
LastUpdateDate: 02/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SZEWC
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: G
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2102771418
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X008090TXY Ambulatory Health Care FacilitiesClinic/Center 

ID Information
IDTypeStateIssuerDescription
16737250105TX MEDICAID


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