MEDICARE: STEPHANIE TRIANA, PH.D. LLC

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	103T00000X	Psychologist	36505	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00P81Q	OTHER		BCBS

General Provider Information

NPI Number	:	1851813323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE TRIANA, PH.D. LLC

Provider Business Mailing Address
First Line	:	21015 LA PENA DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2935
Country	:	US
Telephone Number	:	210-346-0775
Fax Number	:	210-775-0088

Provider Business Practice Location Address
First Line	:	1848 LOCKHILL SELMA RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1566
Country	:	US
Telephone Number	:	210-346-0775
Fax Number	:	210-775-0088

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE TRIANA
Credential	:	PH.D.
Telephone Number	:	210-346-0775

Provider Enumeration Date	:	07/16/2017
Last Update Date	:	09/27/2017

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