Healthcare Provider Details

I. General information

NPI: 1730199811
Provider Name (Legal Business Name): EDUARDO IBARGUEN-SECCHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 MEDICAL DR SUITE 540
SAN ANTONIO TX
78229-6306
US

IV. Provider business mailing address

4410 MEDICAL DR SUITE 540
SAN ANTONIO TX
78229-6306
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-6240
  • Fax: 210-575-6280
Mailing address:
  • Phone: 210-575-6240
  • Fax: 210-575-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberH5572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: