Provider Demographics
NPI:1104613470
Name:NIUMATA, ALEXIS JEANETTE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JEANETTE
Last Name:NIUMATA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 RYDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2000
Mailing Address - Country:US
Mailing Address - Phone:210-346-8627
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 810
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2163
Practice Address - Country:US
Practice Address - Phone:210-346-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician