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General NPI Number Information
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NPI Number | 1073625430
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Entity Type | Individual
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Provider Name | FAROOQ MIRZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 333 N SANTA ROSA AVE CHRISTUS SANTA ROSA CHILDRENS HOSPITAL
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3108
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Country | US
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Telephone | 210-704-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 110 PAINTED POST LN
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City | SHAVANO PARK
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State | TX
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Zip | 78231-1414
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | F5657
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License Number State | TX
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