Healthcare Provider Details

I. General information

NPI: 1619265220
Provider Name (Legal Business Name): ACORN PEDIATRICS OF SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 HUEBNER RD # 9
SAN ANTONIO TX
78248-0959
US

IV. Provider business mailing address

PO BOX 781876
SAN ANTONIO TX
78278-1876
US

V. Phone/Fax

Practice location:
  • Phone: 210-697-2400
  • Fax: 210-697-2401
Mailing address:
  • Phone: 210-697-2400
  • Fax: 210-697-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM0357
License Number StateTX

VIII. Authorized Official

Name: DR. SARAH D BOURLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 210-697-2400