Healthcare Provider Details

I. General information

NPI: 1679394100
Provider Name (Legal Business Name): CATALINA ICE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 CAMDEN ST
SAN ANTONIO TX
78215-1612
US

IV. Provider business mailing address

621 CAMDEN ST STE 202
SAN ANTONIO TX
78215-1644
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3422
  • Fax:
Mailing address:
  • Phone: 210-253-3422
  • Fax: 210-764-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1177823
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: