Provider Demographics
NPI:1174499719
Name:ALCAZAR, ANFERNEE ISAIAH
Entity type:Individual
Prefix:
First Name:ANFERNEE
Middle Name:ISAIAH
Last Name:ALCAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 AMERICAN ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7583
Mailing Address - Country:US
Mailing Address - Phone:210-665-9902
Mailing Address - Fax:
Practice Address - Street 1:12125 ALAMO RANCH PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4334
Practice Address - Country:US
Practice Address - Phone:210-688-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45410390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program