Healthcare Provider Details

I. General information

NPI: 1437136207
Provider Name (Legal Business Name): CECILIA A. VAN BIBBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH BY DESIGN 13409 GEORGE RD
SAN ANTONIO TX
78230
US

IV. Provider business mailing address

HEALTH BY DESIGN 13409 GEORGE RD
SAN ANTONIO TX
78230
US

V. Phone/Fax

Practice location:
  • Phone: 210-345-4855
  • Fax: 210-479-2010
Mailing address:
  • Phone: 210-345-4855
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH8478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: