Healthcare Provider Details

I. General information

NPI: 1710565130
Provider Name (Legal Business Name): STEPHANIE LYNN RODRIGUEZ PENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

IV. Provider business mailing address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-1400
  • Fax: 210-431-7472
Mailing address:
  • Phone: 210-434-1400
  • Fax: 210-431-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10076331
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU8580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: