Healthcare Provider Details

I. General information

NPI: 1073302584
Provider Name (Legal Business Name): JESSICA TORO ROSARIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7727 POTRANCO RD APT 5301
SAN ANTONIO TX
78251-2005
US

V. Phone/Fax

Practice location:
  • Phone: 361-243-9946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number40649
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: