Healthcare Provider Details

I. General information

NPI: 1457447880
Provider Name (Legal Business Name): RUBEN ZEPEDA MIRELES RN,CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER BLVD.
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

885 COUNTY ROAD 375
SAN ANTONIO TX
78253
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax: 210-949-3311
Mailing address:
  • Phone: 210-887-6974
  • Fax: 210-949-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License NumberPF0111
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: