=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699852665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XAVIER RAMON CORTADA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13750 SAN PEDRO AVE SUITE 850
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-3434
-----------------------------------------------------
Fax | 210-489-4977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13750 SAN PEDRO AVE SUITE 850
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-3434
-----------------------------------------------------
Fax | 210-489-4977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | H3666
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------