Individual provider · Type 1 NPI
Israel D. Custodio, PA-C
Medical Physician Assistant · San Antonio, TX
NPI number
1366570087
Active
Practice location
4805 Fredericksburg Rd
San Antonio, TX 78229-3627
Fax (210) 798-2457
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA01549 (TX) |
Medical Physician Assistant: Definition to come...
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About NPI 1366570087
Israel D. Custodio, PA-C's National Provider Identifier is 1366570087, issued on Mar 2, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in San Antonio, TX. The record was last updated on Jul 8, 2007.