Healthcare Provider Details

I. General information

NPI: 1306583646
Provider Name (Legal Business Name): LITTLE SPURS DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24200 IH 10 W
SAN ANTONIO TX
78257-1145
US

IV. Provider business mailing address

14100 SAN PEDRO AVE STE 608
SAN ANTONIO TX
78232-4363
US

V. Phone/Fax

Practice location:
  • Phone: 210-263-9443
  • Fax: 726-999-2625
Mailing address:
  • Phone: 210-543-7334
  • Fax: 210-314-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA TEZEL
Title or Position: CMO
Credential: MD
Phone: 210-543-7334