Healthcare Provider Details

I. General information

NPI: 1275969982
Provider Name (Legal Business Name): PRABHJOT RANDEV MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5542 WALZEM RD
WINDCREST TX
78218-2103
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-7000
  • Fax: 210-637-2499
Mailing address:
  • Phone: 210-922-7000
  • Fax: 210-637-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR0105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: