Healthcare Provider Details

I. General information

NPI: 1073256962
Provider Name (Legal Business Name): SONIA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WESTOVER HILLS BLVD STE 108
SAN ANTONIO TX
78251-4842
US

IV. Provider business mailing address

9730 WESTOVER HILLS BLVD STE 108
SAN ANTONIO TX
78251-4842
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax:
Mailing address:
  • Phone: 210-366-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number203445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: