Provider Demographics
NPI:1184102147
Name:CIBOLO-SOUTH TEXAS CENTER FOR PEDIATRIC CARE
Entity type:Organization
Organization Name:CIBOLO-SOUTH TEXAS CENTER FOR PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-561-3100
Mailing Address - Street 1:13750 SAN PEDRO AVE SUITE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEXAR
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-561-3100
Mailing Address - Fax:210-224-6367
Practice Address - Street 1:580 CIBOLO VALLEY DRIVE
Practice Address - Street 2:SUITE 221
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108
Practice Address - Country:US
Practice Address - Phone:210-561-3100
Practice Address - Fax:210-224-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty