Healthcare Provider Details

I. General information

NPI: 1710037940
Provider Name (Legal Business Name): ANTONIA LOIZ BRONSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 NORWOOD PLZ SUITE A
HURST TX
76054-3748
US

IV. Provider business mailing address

1832 NORWOOD PLZ SUITE A
HURST TX
76054-3748
US

V. Phone/Fax

Practice location:
  • Phone: 817-280-0016
  • Fax: 817-280-0622
Mailing address:
  • Phone: 817-280-0016
  • Fax: 817-280-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTXG7084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: