Healthcare Provider Details

I. General information

NPI: 1205089406
Provider Name (Legal Business Name): PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 FLOYD CURL DR
SAN ANTONIO TX
78229-3902
US

IV. Provider business mailing address

7711 LOUIS PASTEUR DR STE 708
SAN ANTONIO TX
78229-3415
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-7827
  • Fax: 866-741-3697
Mailing address:
  • Phone: 210-575-7828
  • Fax: 866-741-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBERTA S CLOUD
Title or Position: VICE PRESIDENT OF MANAGING MEMBER
Credential:
Phone: 210-575-7827