Provider Demographics
NPI:1891278339
Name:MUJICA, ALFREDO JR
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:MUJICA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10534 TIMBER COUNTRY , SAN ANTONIO, TX, 78254
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254
Mailing Address - Country:US
Mailing Address - Phone:956-251-6963
Mailing Address - Fax:
Practice Address - Street 1:4211 GARDENDALE ST STE A201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3180
Practice Address - Country:US
Practice Address - Phone:210-614-4434
Practice Address - Fax:210-614-4407
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36163OtherTEXAS BOARD OF SPEECH AND LANGUAGE