Healthcare Provider Details

I. General information

NPI: 1205062189
Provider Name (Legal Business Name): MYRIAM SORAYA BARRAGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MARTIN ST
SAN ANTONIO TX
78207
US

IV. Provider business mailing address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-5467
  • Fax:
Mailing address:
  • Phone: 210-358-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberQ4363
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME136162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: