Healthcare Provider Details

I. General information

NPI: 1447434865
Provider Name (Legal Business Name): ILLEANA D SILVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 240
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

PO BOX 734812
DALLAS TX
75373-4812
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-8820
  • Fax: 210-702-4340
Mailing address:
  • Phone: 210-358-9500
  • Fax: 210-358-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN5402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: