Healthcare Provider Details

I. General information

NPI: 1669693370
Provider Name (Legal Business Name): URSULA BALTHAZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SONTERRA BLVD STE 220
SAN ANTONIO TX
78258-4185
US

IV. Provider business mailing address

PO BOX 632593
CINCINNATI OH
45263-2593
US

V. Phone/Fax

Practice location:
  • Phone: 210-337-8453
  • Fax: 210-337-8452
Mailing address:
  • Phone: 713-300-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberP8575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: