MEDICARE: DR. BERTHA DIANA DEL RIO SAYRE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	048-0000853	VT

General Provider Information

NPI Number	:	1528439726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTHA DIANA DEL RIO SAYRE PSY.D.

Provider Business Mailing Address
First Line	:	3411 CREST NOCHE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2857
Country	:	US
Telephone Number	:	512-619-4657
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 CREST NOCHE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2857
Country	:	US
Telephone Number	:	512-619-4657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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