Healthcare Provider Details

I. General information

NPI: 1336821180
Provider Name (Legal Business Name): JUBILEE D HUERTA A.T.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 LOUIS PASTEUR DR
SAN ANTONIO TX
78229-3402
US

IV. Provider business mailing address

7718 LOUIS PASTEUR DR
SAN ANTONIO TX
78229-3402
US

V. Phone/Fax

Practice location:
  • Phone: 105-472-3632
  • Fax:
Mailing address:
  • Phone: 210-373-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberATP95934
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: