Provider Demographics
NPI:1841282332
Name:MIRAMONTES, LORETTA MAY (MD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MAY
Last Name:MIRAMONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:MAY
Other - Last Name:CHURCHILL-MIRAMONTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 HAVEN FOR HOPE WAY
Mailing Address - Street 2:BLDG.1, STE. 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-1108
Mailing Address - Country:US
Mailing Address - Phone:210-220-2370
Mailing Address - Fax:210-220-2499
Practice Address - Street 1:1 HAVEN FOR HOPE WAY
Practice Address - Street 2:BLDG.1, STE. 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1108
Practice Address - Country:US
Practice Address - Phone:210-220-2370
Practice Address - Fax:210-220-2499
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8244207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110281601Medicaid
TXB24926Medicare UPIN