Provider Demographics
NPI:1881734341
Name:CHILDREN'S HEART SPECIALIST, PA
Entity type:Organization
Organization Name:CHILDREN'S HEART SPECIALIST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES-CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:210-886-9725
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-886-9725
Mailing Address - Fax:210-886-0093
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 704
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-886-9725
Practice Address - Fax:210-886-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty