Healthcare Provider Details

I. General information

NPI: 1720274186
Provider Name (Legal Business Name): DEBRA J ARCHULETA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

IV. Provider business mailing address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0100
  • Fax:
Mailing address:
  • Phone: 210-202-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: