ILLUMINATE PEDIATRIC THERAPY, PLLC
Restorative Service Providers at Babcock Rd, San Antonio, TX

License number
Texas 110160
Category
Restorative Service Providers
Type
Pediatrics
Owner
Name: RICARDO ANTONIO ALVARADO M.D.
Title: OWNER / PHYSICIAN
Phone: (210) 286-2703
Address
Address
5804 Babcock Rd #318, San Antonio, TX 78240
National Provider ID: 1235446832
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ILLUMINATE PEDIATRIC THERAPY, P.L.L.C

San Antonio, TX

Industry:
Medical Doctor's Office
Doing business as:
Illuminate Pediatric Therapy, P.L.L.C
Registration:
Jul 28, 2010
Addresses:
5804 Babcock Rd STE 318, San Antonio, TX 78240 (Mailing)
111 Soledad St, San Antonio, TX 78205
State ID:
0801299176
Business type:
Domestic Limited Liability Company (LLC)
Members:
Ricardo Alvarado (Vice Presi, Director, Vice President), 5804 Bahcock Rd, San Antonio, TX 78240,Carrie R. Alvarado Member, inactive
Agent:
Ernesto Martinez,111 Soledad St SUITE 300, San Antonio, TX 78205 (Physical)
TIN:
32042327331

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