Healthcare Provider Details

I. General information

NPI: 1932929965
Provider Name (Legal Business Name): JRYWAN HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

V. Phone/Fax

Practice location:
  • Phone: 210-706-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1177886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: