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NPI Code Detail

MEDICARE: DR. MITRA KERMANI PHD

MEDICARE: DR. MITRA KERMANI PHD
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
1101Y00000XCounselor
2103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1821500075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITRA KERMANI PHD
Provider Business Mailing Address
First Line : 29 TROPHY RDG
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-7715
Country : US
Telephone Number : 210-473-9250
Fax Number :
Provider Business Practice Location Address
First Line : 401 E SONTERRA BLVD STE 375
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4321
Country : US
Telephone Number : 210-473-9258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2017
Last Update Date : 10/27/2017

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Directions to “ DR. MITRA KERMANI PHD” Practice Location

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