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General NPI Number Information
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NPI Number | 1538141114
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Entity Type | Individual
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Provider Name | ESTELA SAMONTE MIRANDA MD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3851 ROGER BROOKE DR MCHE-QD (CREDS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4501
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Country | US
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Telephone | 210-916-1600
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Fax | 210-916-4040
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Provider Business Mailing Address
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Address Line | 311 CLUBHILL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1906
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Country | US
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Telephone | 210-733-6568
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Fax | 210-680-2502
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G4171
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License Number State | TX
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