Healthcare Provider Details

I. General information

NPI: 1730659814
Provider Name (Legal Business Name): ANA SILVIA DORANTES VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 02/26/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E SANTA CLARA ST
SAN JOSE CA
95113-1827
US

IV. Provider business mailing address

2105 TX-1604 LOOP
SAN ANTONIO TX
78245
US

V. Phone/Fax

Practice location:
  • Phone: 866-227-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number8093
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: