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1659480747

NPI Code Detail

MEDICARE: MANIZEH MIRZA-GRUBER MD

MEDICARE: MANIZEH MIRZA-GRUBER MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	J4357	TX
2	2084P0800X	Psychiatry Physician	J4357	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659480747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANIZEH MIRZA-GRUBER MD

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1060
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	1 HAVEN FOR HOPE WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-1266
Country	:	US
Telephone Number	:	210-261-1437
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/25/2024

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Directions to “ MANIZEH MIRZA-GRUBER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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