Provider Demographics
NPI:1083270086
Name:RANGEL, ERNESTINE LEE
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:LEE
Last Name:RANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 BURNING ARROW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2765
Mailing Address - Country:US
Mailing Address - Phone:210-324-1553
Mailing Address - Fax:
Practice Address - Street 1:1346 BURNING ARROW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2765
Practice Address - Country:US
Practice Address - Phone:210-324-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician