1891278339 NPI number — ALFREDO MUJICA JR.

Table of content: ALFREDO MUJICA JR. (NPI 1891278339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891278339 NPI number — ALFREDO MUJICA JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUJICA
Provider First Name:
ALFREDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891278339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10534 TIMBER COUNTRY , SAN ANTONIO, TX, 78254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-251-6963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 GARDENDALE ST STE A201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-4434
Provider Business Practice Location Address Fax Number:
210-614-4407
Provider Enumeration Date:
09/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36163 . This is a "TEXAS BOARD OF SPEECH AND LANGUAGE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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