Organization
PEDIATRIC HEROES PRIMARY CARE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLISCHA HALL (OWNER)
(240) 605-3767
Entity
Organization
Contact information
Practice address
21970 BULVERDE RD, SAN ANTONIO, TX 78259-2178
(240) 605-3767
Mailing address
20403 ENCINO LEDGE UNIT 592625, SAN ANTONIO, TX 78259-0869
(240) 605-3767
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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