Provider Demographics
NPI:1053654798
Name:BARRERA, JAQUELINE AIDE
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:AIDE
Last Name:BARRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 N RAUL LONGORIA RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3720
Mailing Address - Country:US
Mailing Address - Phone:956-782-5800
Mailing Address - Fax:956-782-5802
Practice Address - Street 1:1205 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3720
Practice Address - Country:US
Practice Address - Phone:956-782-5800
Practice Address - Fax:956-782-5802
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211708224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant