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700 N Veterans Blvd Ste E San Juan TX 78589-3226 | |
| (956) 685-5377 | |
| (956) 685-5357 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 700 N Veterans Blvd Ste E, San Juan, Texas |
| Authorized Official Name and Position | Yomeida Medina (OFFICE MANAGER) |
| Authorized Official Contact | 9566855377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
700 N Veterans Blvd Ste E San Juan TX 78589-3226 Ph: (956) 685-5377 | 700 N Veterans Blvd Ste E San Juan TX 78589-3226 Ph: (956) 685-5377 |
| NPI Number | 1205209186 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 10/23/2023 |
| Certification Date | 10/23/2023 |
| Medicare PECOS PAC ID | 8628372661 |
|---|---|
| Medicare Enrollment ID | O20160211000416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205209186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 33917 (Texas) | Primary |
| Provider Name | Vittorio T Puente |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013232081 PECOS PAC ID: 7810027000 Enrollment ID: I20100615000370 |
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