Healthcare Provider Details

I. General information

NPI: 1073310868
Provider Name (Legal Business Name): ALYSSA YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 INTERPARK BLVD STE 104
SAN ANTONIO TX
78216-1844
US

IV. Provider business mailing address

10503 WEST AVE APT 3102
SAN ANTONIO TX
78213-2413
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 808-589-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: