Healthcare Provider Details

I. General information

NPI: 1861575656
Provider Name (Legal Business Name): MELINDA GLORIA FIERROS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 DE ZAVALA RD # A236
SAN ANTONIO TX
78249-2115
US

IV. Provider business mailing address

PO BOX 1098
DALLAS NC
28034-1098
US

V. Phone/Fax

Practice location:
  • Phone: 210-399-2740
  • Fax: 210-399-3231
Mailing address:
  • Phone: 727-800-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ7190
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberQ7190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: