Healthcare Provider Details

I. General information

NPI: 1972507861
Provider Name (Legal Business Name): DIANNA MOSLEY BURNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 E HOUSTON ST RM 104
SAN ANTONIO TX
78202-2952
US

IV. Provider business mailing address

13750 SAN PEDRO AVE STE 560
SAN ANTONIO TX
78232-4375
US

V. Phone/Fax

Practice location:
  • Phone: 210-227-2100
  • Fax: 210-227-1915
Mailing address:
  • Phone: 210-561-3100
  • Fax: 210-545-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG7179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: