Healthcare Provider Details

I. General information

NPI: 1427328046
Provider Name (Legal Business Name): AT HOME FOOT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E SONTERRA BLVD
SAN ANTONIO TX
78258-4278
US

IV. Provider business mailing address

14726 HIDDEN GLEN WOODS
SAN ANTONIO TX
78249-1466
US

V. Phone/Fax

Practice location:
  • Phone: 210-852-2427
  • Fax: 210-598-7278
Mailing address:
  • Phone: 210-852-2427
  • Fax: 210-598-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON EDWARD MIRELES
Title or Position: OWNER
Credential: DPM
Phone: 210-710-7547