Healthcare Provider Details

I. General information

NPI: 1467629550
Provider Name (Legal Business Name): JOHRA NASREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 VILLAGE DRIVE
SAN ANTONIO TX
78217
US

IV. Provider business mailing address

8811 VILLAGE DRIVE
SAN ANTONIO TX
78217
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-6500
  • Fax: 210-297-2098
Mailing address:
  • Phone: 210-297-6500
  • Fax: 210-297-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP0451
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP0451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: