Healthcare Provider Details

I. General information

NPI: 1336083369
Provider Name (Legal Business Name): CREATIVE CARE PEDIATRIC HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 HUEBNER RD STE 113
SAN ANTONIO TX
78248-1676
US

IV. Provider business mailing address

16535 HUEBNER RD STE 113
SAN ANTONIO TX
78248-1676
US

V. Phone/Fax

Practice location:
  • Phone: 210-796-6572
  • Fax: 210-594-0850
Mailing address:
  • Phone: 210-796-6572
  • Fax: 210-594-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA K DEFOREST
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 210-796-6572