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General NPI Number Information
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NPI Number | 1730480039
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Entity Type | Individual
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Provider Name | CLARISSA VINCENT CARVALHO NP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 2121 SW 36TH ST # MS 63-2
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City | SAN ANTONIO
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State | TX
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Zip | 78237-3360
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Country | US
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Telephone | 210-358-5100
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Fax | 210-358-5157
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | SAN ANTONIO
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State | TX
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Zip | 78291-0087
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Country | US
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Telephone | 210-358-9174
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Fax | 210-358-5753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 700234
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License Number State | TX
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