Healthcare Provider Details

I. General information

NPI: 1790480929
Provider Name (Legal Business Name): LAURA ELENA SEXTO CINTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 GUADALUPE ST STE 107
SAN ANTONIO TX
78207-5582
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-5343
  • Fax: 210-924-1374
Mailing address:
  • Phone: 210-922-7000
  • Fax: 210-271-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW4203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: