Healthcare Provider Details

I. General information

NPI: 1053300178
Provider Name (Legal Business Name): KENYA SHORT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENYA BROOKS M.D.

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 BABCOCK RD STE 19
SAN ANTONIO TX
78229-4437
US

IV. Provider business mailing address

7434 LOUIS PASTEUR DR STE 209
SAN ANTONIO TX
78229-4540
US

V. Phone/Fax

Practice location:
  • Phone: 210-761-9001
  • Fax:
Mailing address:
  • Phone: 210-761-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: