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General NPI Number Information
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NPI Number | 1497790703
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Entity Type | Organization
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Legal Business Name | PEDIATRIC INSTITUTE OF SOUTHWEST TEXAS,P.A.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 5255 PRUE RD SUITE #105
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1335
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Country | US
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Telephone | 210-877-9966
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Fax | 210-877-1162
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Provider Business Mailing Address
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Address Line | 5255 PRUE RD SUITE #105
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1335
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Country | US
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Telephone | 210-877-9966
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Fax | 210-877-1162
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. KASSIA LOUEVA KUBENA
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Credential | M.D.,
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Telephone | 210-877-9966
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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 |
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License Number State |
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