Provider Demographics
NPI:1578186136
Name:STATERA CLINICAL AND FORENSIC SERVICES, PLLC
Entity Type:Organization
Organization Name:STATERA CLINICAL AND FORENSIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASISCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUJOLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:956-320-7036
Mailing Address - Street 1:1002 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7108
Mailing Address - Country:US
Mailing Address - Phone:956-320-7036
Mailing Address - Fax:
Practice Address - Street 1:1002 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7108
Practice Address - Country:US
Practice Address - Phone:956-320-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty