Healthcare Provider Details

I. General information

NPI: 1306370846
Provider Name (Legal Business Name): VERONICA JUAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA KORTHALS M.D.

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-2078
  • Fax: 210-702-6274
Mailing address:
  • Phone: 210-358-2078
  • Fax: 210-702-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU5137
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberU5137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: