Provider Demographics
NPI:1457497950
Name:YSAGUIRRE, NOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:YSAGUIRRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 N 10TH ST UNIT 29
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9423
Mailing Address - Country:US
Mailing Address - Phone:956-687-1833
Mailing Address - Fax:
Practice Address - Street 1:9601 N 10TH ST UNIT 29
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-9423
Practice Address - Country:US
Practice Address - Phone:956-687-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24543103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81417POtherBLUE CROSS BLUE SHIELD
TX146963701Medicaid
TX81417PMedicare PIN