MEDICARE: EMMA PATRICIA MIGUEL

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	390200000X	Student in an Organized Health Care Education/Training Program		TX
2	1223G0001X	General Practice Dentistry	40478	TX

General Provider Information

NPI Number	:	1588364293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA PATRICIA MIGUEL

Provider Business Mailing Address
First Line	:	11822 WILDCAT CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-6276
Country	:	US
Telephone Number	:	210-454-8841
Fax Number	:

Provider Business Practice Location Address
First Line	:	937 EVENTIDE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5546
Country	:	US
Telephone Number	:	210-824-0430
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	06/20/2024

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Directions to “ EMMA PATRICIA MIGUEL ” Practice Location

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