Healthcare Provider Details

I. General information

NPI: 1356840151
Provider Name (Legal Business Name): ANDONI ZAGOURIS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 TARRINGTON LN
KINGSLAND TX
78639-7863
US

IV. Provider business mailing address

221 TARRINGTON LN
KINGSLAND TX
78639
US

V. Phone/Fax

Practice location:
  • Phone: 956-369-2995
  • Fax:
Mailing address:
  • Phone: 956-369-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number16820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: