Healthcare Provider Details

I. General information

NPI: 1073507810
Provider Name (Legal Business Name): ALBERTO SAMUEL CARRANZA M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA AVE
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

315 N SAN SABA SUITE 1135
SAN ANTONIO TX
78207-3154
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-2190
  • Fax: 210-704-3374
Mailing address:
  • Phone: 210-704-2937
  • Fax: 210-704-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL8640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: