Healthcare Provider Details

I. General information

NPI: 1528752284
Provider Name (Legal Business Name): ADRIANA DELGADO STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

233 TWIN OAKS DR
LA VERNIA TX
78121-4519
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax:
Mailing address:
  • Phone: 210-632-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number217553
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: