MEDICARE: PEDI PLACE AT WESTOVER HILLS

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

General Provider Information

NPI Number	:	1962521849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDI PLACE AT WESTOVER HILLS

Provider Business Mailing Address
First Line	:	3207 ROGERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4826
Country	:	US
Telephone Number	:	210-680-7334
Fax Number	:	210-680-7337

Provider Business Practice Location Address
First Line	:	3207 ROGERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4826
Country	:	US
Telephone Number	:	210-680-7334
Fax Number	:	210-680-7337

Authorized Official
Title or Position	:	OWNER
Name	:	YVONNE MIRANDA
Credential	:	MD
Telephone Number	:	210-680-7334

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	01/30/2024

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Directions to “PEDI PLACE AT WESTOVER HILLS ” Practice Location

Language	Start Address	Practice Location

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