MEDICARE: DR. CLARISSA M AGUILAR PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1184703639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA M AGUILAR PH.D.

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1060
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	5372 FREDERICKSBURG RD BLDG F
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3558
Country	:	US
Telephone Number	:	210-261-1600
Fax Number	:	210-615-5721

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	05/31/2023

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