Basic Information
| Provider Information | |||||||||
| NPI: | 1447356829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UNZUETA-HERNANDEZ | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | UNZUETA | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1141 N 1604 E # 105-424 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782321397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104953627 | ||||||||
| FaxNumber: | 2104913581 | ||||||||
| Practice Location | |||||||||
| Address1: | 17720 CORPORATE WOODS DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782593500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104953627 | ||||||||
| FaxNumber: | 2104913581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 05/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | BP10017193 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2051005 | 05 | TX | MEDICAID |