Healthcare Provider Details

I. General information

NPI: 1740700111
Provider Name (Legal Business Name): M. REZA MIZANI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N SAN SABA STE 201
SAN ANTONIO TX
78207-3120
US

IV. Provider business mailing address

PO BOX 650002 DEPT 8286
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 210-547-3430
  • Fax: 210-229-0606
Mailing address:
  • Phone: 210-212-8622
  • Fax: 210-212-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number130337
License Number StateTX

VIII. Authorized Official

Name: DR. MOHAMMAD REZA MIZANI
Title or Position: PRESIDENT
Credential: MD
Phone: 210-212-8622