Healthcare Provider Details

I. General information

NPI: 1336715069
Provider Name (Legal Business Name): KAYLA ROSE WALTER RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ROSE WALTER MD

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 HUEBNER RD STE 15
SAN ANTONIO TX
78248-0983
US

IV. Provider business mailing address

15303 HUEBNER RD STE 15
SAN ANTONIO TX
78248-0983
US

V. Phone/Fax

Practice location:
  • Phone: 210-697-2400
  • Fax: 210-697-2401
Mailing address:
  • Phone: 210-697-2400
  • Fax: 210-697-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW7483
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0073063
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: