1275767295 NPI number — MRS. ALISA ZINSMEYER YOUNG M.A., L.P.C.

Table of content: MRS. ALISA ZINSMEYER YOUNG M.A., L.P.C. (NPI 1275767295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275767295 NPI number — MRS. ALISA ZINSMEYER YOUNG M.A., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
ALISA
Provider Middle Name:
ZINSMEYER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZINSMEYER
Provider Other First Name:
ALISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275767295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4242 MEDICAL DR STE 6250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-3011
Provider Business Mailing Address Fax Number:
210-615-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4242 MEDICAL DR STE 6250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-3011
Provider Business Practice Location Address Fax Number:
210-615-6906
Provider Enumeration Date:
05/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  63304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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