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General NPI Number Information
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NPI Number | 1215345202
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Entity Type | Organization
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Legal Business Name | WONDER KIDS PEDIATRICS, PLLC
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 20818 GATHERING OAK SUITE 109
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City | SAN ANTONIO
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State | TX
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Zip | 78260-3104
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Country | US
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Telephone | 210-762-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 18815 MILLHOLLOW
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4258
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Country | US
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Telephone | 210-392-3506
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. DEMETRIOS G LEILOGLOU
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Credential | M.D.
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Telephone | 210-392-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L2984
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License Number State | TX
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