Healthcare Provider Details

I. General information

NPI: 1811056542
Provider Name (Legal Business Name): DOWNTOWN SOUTH TEXAS CENTER FOR PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 E HOUSTON ST SUITE 104
SAN ANTONIO TX
78202-2951
US

IV. Provider business mailing address

1954 E HOUSTON ST SUITE 104
SAN ANTONIO TX
78202-2951
US

V. Phone/Fax

Practice location:
  • Phone: 210-227-2100
  • Fax: 210-227-1915
Mailing address:
  • Phone: 210-227-2100
  • Fax: 210-227-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA M DALUZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 210-576-0533