MEDICARE: MARIA-ALICIA LONGORIA

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	152W00000X	Optometrist	11562TG	TX

General Provider Information

NPI Number	:	1255206025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA-ALICIA LONGORIA

Provider Business Mailing Address
First Line	:	4103 ROGERS RD APT 8310
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9218 POTRANCO RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2274
Country	:	US
Telephone Number	:	210-858-4001
Fax Number	:

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

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/27/2025

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Directions to “ MARIA-ALICIA LONGORIA ” Practice Location

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