Provider Demographics
NPI:1073389748
Name:RINCON, JACOB OVIDIO
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:OVIDIO
Last Name:RINCON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-2539
Mailing Address - Country:US
Mailing Address - Phone:210-716-0750
Mailing Address - Fax:210-783-9721
Practice Address - Street 1:2318 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-2539
Practice Address - Country:US
Practice Address - Phone:210-716-0750
Practice Address - Fax:210-783-9721
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist