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General NPI Number Information
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NPI Number | 1427328046
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Entity Type | Organization
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Legal Business Name | AT HOME FOOT CARE PLLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 1314 E SONTERRA BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4278
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Country | US
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Telephone | 210-852-2427
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Fax | 210-598-7278
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Provider Business Mailing Address
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Address Line | 14726 HIDDEN GLEN WOODS
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1466
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Country | US
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Telephone | 210-852-2427
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Fax | 210-598-7278
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON EDWARD MIRELES
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Credential | DPM
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Telephone | 210-710-7547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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