Individual
JACQUELINE HEREDIA GRACIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2192 ROSITA VALLEY RD, EAGLE PASS, TX 78852-2503
(830) 421-5349
(830) 421-5417
Mailing address
2192 ROSITA VALLEY RD, EAGLE PASS, TX 78852-2503
(830) 421-5349
(830) 421-5417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
P7646
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
691720
AMERICAN BOARD OF PEDIATRICS CERTIFICATION
TX
01
—
P7646
TX MEDICAL BOARD PHYSICIAN FULL PERMIT
TX
Enumeration date
04/01/2010
Last updated
02/16/2016
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