Basic Information
| Provider Information | |||||||||
| NPI: | 1093761009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEJESUS | ||||||||
| FirstName: | ELVIRA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN-CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 IH 10 W | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782015159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107311300 | ||||||||
| FaxNumber: | 2107388025 | ||||||||
| Practice Location | |||||||||
| Address1: | 527 N LEONA ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782073110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107311300 | ||||||||
| FaxNumber: | 2107388025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 444580 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 151331903 | 05 | TX | MEDICAID |