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NPI Code Detail

MEDICARE: DIANA CAROLINA JUSINO LICENSED VOCATIONAL

MEDICARE: DIANA CAROLINA JUSINO LICENSED VOCATIONAL
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
1164X00000XLicensed Vocational Nurse332466TX

General Provider Information

NPI Number : 1215416193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA CAROLINA JUSINO LICENSED VOCATIONAL
Provider Business Mailing Address
First Line : 14111 VANCE JACKSON RD APT 33207
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2190
Country : US
Telephone Number : 210-262-2322
Fax Number :
Provider Business Practice Location Address
First Line : 8700 CROWNHILL BLVD STE 300
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78209-1128
Country : US
Telephone Number : 210-824-5530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2018
Last Update Date : 08/10/2018

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Directions to “ DIANA CAROLINA JUSINO LICENSED VOCATIONAL” Practice Location

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