Healthcare Provider Details

I. General information

NPI: 1669353843
Provider Name (Legal Business Name): MICAH JOEL YZAGUIRRE ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4458 MEDICAL DR STE 505
SAN ANTONIO TX
78229-3748
US

IV. Provider business mailing address

148 FABARM LN
NEW BRAUNFELS TX
78130-5178
US

V. Phone/Fax

Practice location:
  • Phone: 210-690-7400
  • Fax:
Mailing address:
  • Phone: 210-317-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1190385
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1190385
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: