Provider Demographics
NPI:1508211848
Name:YRACHETA, JACLYN LIZETTE (MD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:LIZETTE
Last Name:YRACHETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6526 CHAPARRAL LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2606
Mailing Address - Country:US
Mailing Address - Phone:361-219-9521
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 2307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2723
Practice Address - Country:US
Practice Address - Phone:713-486-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program