Healthcare Provider Details

I. General information

NPI: 1154853992
Provider Name (Legal Business Name): FARINO PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 VILLAGE DR SUITE 209
SAN ANTONIO TX
78217-5412
US

IV. Provider business mailing address

516 NOLAN ST
SAN ANTONIO TX
78202-2250
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0100
  • Fax: 210-579-9705
Mailing address:
  • Phone: 512-550-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberR1749
License Number StateTX

VIII. Authorized Official

Name: DR. JETHER CHRISTIAN FARINO
Title or Position: CEO
Credential: M.D.
Phone: 512-550-3380