Healthcare Provider Details

I. General information

NPI: 1669849634
Provider Name (Legal Business Name): ELIZABETH ANN COMMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

IV. Provider business mailing address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-7733
  • Fax: 210-599-3105
Mailing address:
  • Phone: 210-599-7733
  • Fax: 210-599-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: