Healthcare Provider Details

I. General information

NPI: 1508362344
Provider Name (Legal Business Name): ALYSSA MAE GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR STE 102
SAN ANTONIO TX
78229-2042
US

IV. Provider business mailing address

1542 N ALAMO ST UNIT 202
SAN ANTONIO TX
78215-1283
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone: 956-222-3647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: