Most Relevant Information
Provider Data
| NPI Number: | 1003567447 |
| Provider Name: | PAUL JOSEPH FANUCCHI NP |
| Entity Type: | Individual |
| Taxonomy Code: | 207RG0300X |
| Specialty: | Internal Medicine |
| License Number: | AP108274 |
Most Important Dates
| Enumeration Date: | 01/18/2022 |
| Last Updated: | 01/18/2022 |
Provider Practice Location
MARIANIST RESIDENCE
520 FONDHAM
SAN ANTONIO
TX
782284821
Practice Location Phone/Fax
| Phone: | 2104344157 |
| Fax: | 2104336005 |
Provider Mailing Location
MARIANIST RESIDENCE
520 FONDHAM
SAN ANTONIO
TX
782284821
Provider Mailing Phone/Fax
| Phone: | 2104344157 |
| Fax: | 2104336005 |