Healthcare Provider Details

I. General information

NPI: 1104462498
Provider Name (Legal Business Name): JESSICA ALVIAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CLAREMONT AVE UNIT 101
SAN ANTONIO TX
78209-4808
US

IV. Provider business mailing address

103 CLAREMONT AVE UNIT 101
SAN ANTONIO TX
78209-4808
US

V. Phone/Fax

Practice location:
  • Phone: 315-586-3325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: