Provider Demographics
NPI:1164781977
Name:MUNGUIA, MAYRIN CALCANO
Entity Type:Individual
Prefix:
First Name:MAYRIN
Middle Name:CALCANO
Last Name:MUNGUIA
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 1:2200 BERQUIST DR. STE 1
Mailing Address - Street 2:LACKLAND AFB
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 BERQUIST DR.
Practice Address - Street 2:SUITE 1 LACKLAND AFB TX
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-5972
Practice Address - Fax:210-292-5944
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist