Provider Demographics
NPI:1891381331
Name:NEUROPSYCHOLOGICAL INSTITUTE OF SAN ANTONIO PLLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL INSTITUTE OF SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANYNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-860-9622
Mailing Address - Street 1:19016 STONE OAK PKWY BLDG I
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3280
Mailing Address - Country:US
Mailing Address - Phone:210-860-9622
Mailing Address - Fax:844-404-6016
Practice Address - Street 1:19016 STONE OAK PKWY BLDG I
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3280
Practice Address - Country:US
Practice Address - Phone:210-860-9622
Practice Address - Fax:844-404-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32917OtherLICENSE