Provider Demographics
NPI:1447356829
Name:UNZUETA-HERNANDEZ, MARY R (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:R
Last Name:UNZUETA-HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:UNZUETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 N 1604 E # 105-424
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1397
Mailing Address - Country:US
Mailing Address - Phone:210-495-3627
Mailing Address - Fax:210-491-3581
Practice Address - Street 1:17720 CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3500
Practice Address - Country:US
Practice Address - Phone:210-495-3627
Practice Address - Fax:210-491-3581
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100171932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2051005Medicaid