Provider Demographics
NPI:1376291203
Name:PUENTE, ROSELYNN
Entity Type:Individual
Prefix:
First Name:ROSELYNN
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSELYNN
Other - Middle Name:
Other - Last Name:SCRIBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 AIRSTREAM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-4421
Mailing Address - Country:US
Mailing Address - Phone:210-649-5305
Mailing Address - Fax:
Practice Address - Street 1:570 HEIMER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5160
Practice Address - Country:US
Practice Address - Phone:210-885-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB759901106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician