MEDICARE: JACOB OVIDIO RINCON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	204226	TX

General Provider Information

NPI Number	:	1073389748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB OVIDIO RINCON

Provider Business Mailing Address
First Line	:	2318 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2539
Country	:	US
Telephone Number	:	210-716-0750
Fax Number	:	210-783-9721

Provider Business Practice Location Address
First Line	:	2318 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2539
Country	:	US
Telephone Number	:	210-716-0750
Fax Number	:	210-783-9721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ JACOB OVIDIO RINCON ” Practice Location

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