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Organization
SA-LTP PA
Active
Organization
SA-LTP PA
Active
Other names
LITTLE TEXANS PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA M ROCHABRUN (MANAGER)
(210) 402-0138
Entity
Organization
Contact information
Practice address
20306 ENCINO LEDGE, SUITE 101, SAN ANTONIO, TX 78259
(210) 402-0138
(210) 402-0051
Mailing address
20306 ENCINO LEDGE, SUITE 101, SAN ANTONIO, TX 78259
(210) 402-0138
(210) 402-0051
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K3632
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075CL
BLUE CROSS BLUE SHIELD
TX
05
—
092309601
—
TX
05
—
092309602
—
TX
Enumeration date
08/01/2007
Last updated
09/25/2012
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