MEDICARE: JACQUELINE DELFIERRO-AVILA

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	101YM0800X	Mental Health Counselor	67474	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	101YP2500X	Professional Counselor	67474	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396292207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE DELFIERRO-AVILA

Provider Business Mailing Address
First Line	:	550 WARE BLVD.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221
Country	:	US
Telephone Number	:	210-630-8641
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 LARCHMONT DR.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-867-9841
Fax Number	:	210-816-5900

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	01/28/2026

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Directions to “ JACQUELINE DELFIERRO-AVILA ” Practice Location

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