Healthcare Provider Details

I. General information

NPI: 1417454398
Provider Name (Legal Business Name): ALYSSA CARMONA HHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 SOVEREIGN ST STE 240
SAN ANTONIO TX
78229-5134
US

IV. Provider business mailing address

4518 CLEAR SPRING DR
SAN ANTONIO TX
78217-3628
US

V. Phone/Fax

Practice location:
  • Phone: 832-385-6614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: