Healthcare Provider Details

I. General information

NPI: 1093073488
Provider Name (Legal Business Name): MARISOL ARIZMENDI BRETON-LEIJA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W. MARTIN MS 49-2
SAN ANTONIO TX
78207
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3441
  • Fax: 210-358-5944
Mailing address:
  • Phone: 210-358-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number667305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: