MEDICARE: DEER OAKS SOUTHWEST

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	103TC0700X	Clinical Psychologist

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	:	1831354620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER OAKS SOUTHWEST

Provider Business Mailing Address
First Line	:	7272 WURZBACH RD
Second Line	:	SUITE 601
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4801
Country	:	US
Telephone Number	:	210-615-3472
Fax Number	:	210-593-9863

Provider Business Practice Location Address
First Line	:	1112 SAN PEDRO DR NE
Second Line	:	SUITE 222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-6724
Country	:	US
Telephone Number	:	505-254-3505
Fax Number	:	210-593-9863

Authorized Official
Title or Position	:	CEO
Name	:	PAUL ALAN BOSKIND
Credential	:	PH.D.
Telephone Number	:	210-615-3472

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	02/05/2009

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Directions to “DEER OAKS SOUTHWEST ” Practice Location

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