Basic Information
| Provider Information | |||||||||
| NPI: | 1134443690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATEHUALA | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | ISABEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4410 MEDICAL DR STE 410 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105757268 | ||||||||
| FaxNumber: | 2105756131 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105757268 | ||||||||
| FaxNumber: | 2024764741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2010 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD045906 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | S7723 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.