Healthcare Provider Details

I. General information

NPI: 1992909741
Provider Name (Legal Business Name): JENNIFER P DELAGARZA LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HOWARD ST
SAN ANTONIO TX
78212-5524
US

IV. Provider business mailing address

217 HOWARD ST
SAN ANTONIO TX
78212-5524
US

V. Phone/Fax

Practice location:
  • Phone: 210-227-0170
  • Fax: 210-227-0812
Mailing address:
  • Phone: 210-227-0170
  • Fax: 210-227-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number40434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: