Healthcare Provider Details

I. General information

NPI: 1316191141
Provider Name (Legal Business Name): PANDYA MEDICAL P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14080 NACOGDOCHES RD # 313
SAN ANTONIO TX
78247-1944
US

IV. Provider business mailing address

14080 NACOGDOCHES RD # 313
SAN ANTONIO TX
78247-1944
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-1701
  • Fax:
Mailing address:
  • Phone: 210-281-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberN1039
License Number StateTX

VIII. Authorized Official

Name: DR. MAYANK PANDYA
Title or Position: CEO
Credential: M.D.
Phone: 210-281-1701