Provider Demographics
NPI:1962521849
Name:PEDI PLACE AT WESTOVER HILLS
Entity type:Organization
Organization Name:PEDI PLACE AT WESTOVER HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-680-7334
Mailing Address - Street 1:3207 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4826
Mailing Address - Country:US
Mailing Address - Phone:210-680-7334
Mailing Address - Fax:210-680-7337
Practice Address - Street 1:3207 ROGERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4826
Practice Address - Country:US
Practice Address - Phone:210-680-7334
Practice Address - Fax:210-680-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty