Healthcare Provider Details

I. General information

NPI: 1669564902
Provider Name (Legal Business Name): AMY ROSE MULROY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 WURZBACH, STE 305
SAN ANTONIO TX
78230
US

IV. Provider business mailing address

11124 WURZBACH, STE. 305
SAN ANTONIO TX
78230
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-1929
  • Fax: 210-692-1904
Mailing address:
  • Phone: 210-692-1929
  • Fax: 210-692-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ6417
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberJ6417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: