Healthcare Provider Details

I. General information

NPI: 1164092763
Provider Name (Legal Business Name): ANA MICAELA FIGUEROA-JARRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12739 SHORELINE DR
SAN ANTONIO TX
78254-6328
US

IV. Provider business mailing address

12739 SHORELINE DR
SAN ANTONIO TX
78254-6328
US

V. Phone/Fax

Practice location:
  • Phone: 808-453-0881
  • Fax:
Mailing address:
  • Phone: 808-453-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number71906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: