MEDICARE: MRS. MARIA ARACELI VIEYRA

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1588723555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA ARACELI VIEYRA

Provider Business Mailing Address
First Line	:	7155 FALLEN TRAIL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1815
Country	:	US
Telephone Number	:	210-666-1465
Fax Number	:	210-666-1465

Provider Business Practice Location Address
First Line	:	7155 FALLEN TRAIL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1815
Country	:	US
Telephone Number	:	210-666-1465
Fax Number	:	210-666-1465

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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