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NPI Code Detail

MEDICARE: MAYRA VALDIVIA CARLISLE DO

MEDICARE: MAYRA VALDIVIA CARLISLE DO
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
12084P0800XPsychiatry PhysicianV0897TX
22084P0800XPsychiatry Physician339505NY

General Provider Information

NPI Number : 1558980532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYRA VALDIVIA CARLISLE DO
Provider Business Mailing Address
First Line : PO BOX 24449
Second Line :
City : NEW YORK
State : NY
Zip : 10087-0589
Country : US
Telephone Number : 833-351-8255
Fax Number :
Provider Business Practice Location Address
First Line : 7703 FLOYD CURL DR # MC
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-3901
Country : US
Telephone Number : 210-567-1601
Fax Number : 210-567-3483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 01/20/2026

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