Healthcare Provider Details

I. General information

NPI: 1851843833
Provider Name (Legal Business Name): M. REZA MIZANI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N SAN SABA STE 201
SAN ANTONIO TX
78207-3120
US

IV. Provider business mailing address

215 N SAN SABA STE 301
SAN ANTONIO TX
78207-8101
US

V. Phone/Fax

Practice location:
  • Phone: 210-477-3271
  • Fax: 210-477-3274
Mailing address:
  • Phone: 210-212-8622
  • Fax: 210-212-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN7871
License Number StateTX

VIII. Authorized Official

Name: MOHAMMAD REZA MIZANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-212-8622