Healthcare Provider Details

I. General information

NPI: 1134814288
Provider Name (Legal Business Name): LAURA MERCEDES RODRIGUEZ DAVILA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W LOOP 1604 S STE 102
SAN ANTONIO TX
78245-4010
US

IV. Provider business mailing address

695 W LOOP 1604 S STE 102
SAN ANTONIO TX
78245-4010
US

V. Phone/Fax

Practice location:
  • Phone: 210-817-7005
  • Fax: 210-568-6945
Mailing address:
  • Phone: 210-817-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW8615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: