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General NPI Number Information
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NPI Number | 1902037906
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Entity Type | Organization
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Legal Business Name | CRISCAR P.A.
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 3215 STECK AVE STE 205
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City | AUSTIN
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State | TX
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Zip | 78757-7584
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Country | US
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Telephone | 512-467-2500
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Fax | 512-467-2502
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Provider Business Mailing Address
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Address Line | 3215 STECK AVE STE 205
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City | AUSTIN
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State | TX
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Zip | 78757-7584
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Country | US
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Telephone | 512-467-2500
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Fax | 512-467-2502
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIELA JOSEFINA FUENMAYOR
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Credential | M.D.
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Telephone | 512-467-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | M9292
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License Number State | TX
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