Healthcare Provider Details

I. General information

NPI: 1760123897
Provider Name (Legal Business Name): CHARDIEL JANICE DELGADO MIRANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 INTERSTATE HIGHWAY 10 EAST
SAN ANTONIO TX
78220
US

IV. Provider business mailing address

3860 IH 10 EAST HOUSTON ST.
SAN ANTONIO TX
78219
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-5060
  • Fax: 210-702-6926
Mailing address:
  • Phone: 210-644-5060
  • Fax: 210-702-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW0557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: