MEDICARE: DR. KELLY MARIE BASALDUA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	P6137	TX

General Provider Information

NPI Number	:	1396062964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE BASALDUA M.D.

Provider Business Mailing Address
First Line	:	7810 LOUIS PASTEUR DR STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3409
Country	:	US
Telephone Number	:	210-465-1800
Fax Number	:	210-899-1006

Provider Business Practice Location Address
First Line	:	7810 LOUIS PASTEUR DR STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3409
Country	:	US
Telephone Number	:	210-465-1800
Fax Number	:	210-899-1006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2010
Last Update Date	:	06/15/2026

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