Provider Demographics
NPI:1093761009
Name:DEJESUS, ELVIRA S (APN-CNS)
Entity Type:Individual
Prefix:MRS
First Name:ELVIRA
Middle Name:S
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:APN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-731-1300
Mailing Address - Fax:210-738-8025
Practice Address - Street 1:527 N LEONA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3110
Practice Address - Country:US
Practice Address - Phone:210-731-1300
Practice Address - Fax:210-738-8025
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX444580364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151331903Medicaid
TX8D7932Medicare ID - Type UnspecifiedPROVIDER #
TX151331903Medicaid