Provider Demographics
NPI:1578442216
Name:AZALEA HOUSE DAY SPA
Entity type:Organization
Organization Name:AZALEA HOUSE DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:YING
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:ME3992
Authorized Official - Phone:210-409-3636
Mailing Address - Street 1:13402 WEST AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2029
Mailing Address - Country:US
Mailing Address - Phone:210-409-3636
Mailing Address - Fax:
Practice Address - Street 1:13402 WEST AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2029
Practice Address - Country:US
Practice Address - Phone:210-409-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty