Healthcare Provider Details

I. General information

NPI: 1821073438
Provider Name (Legal Business Name): RAFAEL PARRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE SUITE 440
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

1303 MCCULLOUGH AVE SUITE 440
SAN ANTONIO TX
78212-5609
US

V. Phone/Fax

Practice location:
  • Phone: 210-226-8349
  • Fax: 210-227-3918
Mailing address:
  • Phone: 210-226-8349
  • Fax: 210-227-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE4040
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: