Healthcare Provider Details

I. General information

NPI: 1164085650
Provider Name (Legal Business Name): AFFINITY HEALTHCARE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 BREANNA OAKS
SAN ANTONIO TX
78254-5703
US

IV. Provider business mailing address

8902 BREANNA OAKS
SAN ANTONIO TX
78254-5703
US

V. Phone/Fax

Practice location:
  • Phone: 210-573-7683
  • Fax:
Mailing address:
  • Phone: 210-573-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSE A. BARRIOS
Title or Position: ADMINISTRATOR
Credential: RN-BSN, MBA-HA
Phone: 210-573-7683