Healthcare Provider Details

I. General information

NPI: 1598921223
Provider Name (Legal Business Name): CHILDRENS CRITICAL CARE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 FLOYD CURL DR
SAN ANTONIO TX
78229-3902
US

IV. Provider business mailing address

7711 LOUIS PASTEUR DRIVE SUITE 705
SAN ANTONIO TX
78229-3422
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-6919
  • Fax: 210-575-4013
Mailing address:
  • Phone: 210-575-6919
  • Fax: 210-575-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA S. CLOUD
Title or Position: VP
Credential:
Phone: 210-575-6919