Provider Demographics
NPI:1164096186
Name:BIRT, ANGELICA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:MARIA
Last Name:BIRT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:SALINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20131 HORIZON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24870 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-6674
Practice Address - Country:US
Practice Address - Phone:210-447-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician