MEDICARE: DR. RUDOLFO PEDRAZA ZARATE JR. 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	207R00000X	Internal Medicine Physician	35-07-6383	OH
2	207R00000X	Internal Medicine Physician	M1514	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770589384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDOLFO PEDRAZA ZARATE JR. M.D.

Provider Business Mailing Address
First Line	:	24014 GRAN PALACIO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2766
Country	:	US
Telephone Number	:	210-587-8787
Fax Number	:	210-388-0239

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE STE 310
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4810
Country	:	US
Telephone Number	:	210-587-8787
Fax Number	:	210-388-0239

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/20/2020

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Directions to “ DR. RUDOLFO PEDRAZA ZARATE JR. M.D.” Practice Location

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