Healthcare Provider Details

I. General information

NPI: 1194886796
Provider Name (Legal Business Name): PEDICATRIC CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4499 MEDICAL DRIVE SUITE 272
SAN ANTONIO TX
78229-3712
US

IV. Provider business mailing address

4499 MEDICAL DRIVE SUITE 272
SAN ANTONIO TX
78229-3712
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-3264
  • Fax: 210-692-3963
Mailing address:
  • Phone: 210-614-3264
  • Fax: 210-692-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN EVEREST
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 210-614-3264