Basic Information
| Provider Information | |||||||||
| NPI: | 1194907683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENIGAN | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SANTA ROSA ST | ||||||||
| Address2: | SUITE D4023 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782073108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822711 | ||||||||
| FaxNumber: | 4692822609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1434 E SONTERRA BLVD STE 109 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104793000 | ||||||||
| FaxNumber: | 2104793016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N5101 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 218136404 | 05 | TX | MEDICAID | 173321401 | 01 | TX | GROUP TPI | OTHER | 1265475891 | 01 | TX | GROUP NPI NUMBER | OTHER | 173321402 | 01 | TX | GROUP TPI NUMBER-EPSDT | OTHER | 218136401 | 05 | TX | MEDICAID |