Healthcare Provider Details

I. General information

NPI: 1104049170
Provider Name (Legal Business Name): YOLANDA WHITTAKER HILLIARD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 BABCOCK RD SUITE 29 A
SAN ANTONIO TX
78229-4443
US

IV. Provider business mailing address

2020 BABCOCK RD SUITE 29 A
SAN ANTONIO TX
78229-4443
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-7777
  • Fax: 210-614-3049
Mailing address:
  • Phone: 210-614-7777
  • Fax: 210-614-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberF7302
License Number StateTX

VIII. Authorized Official

Name: DR. YOLANDA LAVERN WHITTAKER HILLIARD
Title or Position: PHYSICIAN PRESIDENT
Credential: M.D.
Phone: 210-614-7777