Provider Demographics
NPI:1275014540
Name:ARTEAGA, GRISELDA ANA
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:ANA
Last Name:ARTEAGA
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 1:3553 W HOUSTON HARTE EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-2664
Mailing Address - Country:US
Mailing Address - Phone:325-224-3481
Mailing Address - Fax:
Practice Address - Street 1:3553 W HOUSTON HARTE EXPY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-2664
Practice Address - Country:US
Practice Address - Phone:325-224-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YA0400XMedicaid