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General NPI Number Information
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NPI Number | 1578309951
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Entity Type | Organization
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Legal Business Name | SA PEDIATRIC UROLOGY
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 4499 MEDICAL DR STE 360
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3857
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Country | US
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Telephone | 210-615-1600
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Fax | 210-615-1601
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Provider Business Mailing Address
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Address Line | 4499 MEDICAL DR STE 360
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3857
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Country | US
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Telephone | 210-615-1600
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Fax | 210-615-1601
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Authorized Official
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Title or Position | OWNER
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Name | JUAN CARLOS PRIETO
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Credential | MD
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Telephone | 210-615-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State |
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