Provider Demographics
NPI:1720611718
Name:PRIMERA, ANA ALICIA (CCN)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ALICIA
Last Name:PRIMERA
Suffix:
Gender:F
Credentials:CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4636
Mailing Address - Country:US
Mailing Address - Phone:210-563-3779
Mailing Address - Fax:
Practice Address - Street 1:305 E RAMSEY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4636
Practice Address - Country:US
Practice Address - Phone:210-563-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist