Provider Demographics
NPI:1619501046
Name:ARGUELLO, ANALISA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:
Last Name:ARGUELLO
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2506
Mailing Address - Country:US
Mailing Address - Phone:210-508-9023
Mailing Address - Fax:
Practice Address - Street 1:205 DANDELION LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2506
Practice Address - Country:US
Practice Address - Phone:210-508-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT86332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT8633OtherTDLR
BOC389066OtherBOARD OF CERTIFICATION