Healthcare Provider Details

I. General information

NPI: 1396448924
Provider Name (Legal Business Name): MARIELLE ANDREA BOSQUEZ BRIONES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIELLE ANDREA BOSQUEZ DO

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8366 N LOOP 1604 W STE 105
SAN ANTONIO TX
78249-3533
US

IV. Provider business mailing address

7703 FLOYD CURL DR # MC7816
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-6000
  • Fax: 210-520-0906
Mailing address:
  • Phone: 210-563-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW4766
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: