Provider Demographics
NPI:1316435464
Name:ZARAGOZA DE YOUNG, ALTAGRACIA
Entity type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:
Last Name:ZARAGOZA DE YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BROCK ST STE 23
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3557
Mailing Address - Country:US
Mailing Address - Phone:956-529-5600
Mailing Address - Fax:
Practice Address - Street 1:2406 BROCK ST STE 23
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3557
Practice Address - Country:US
Practice Address - Phone:956-529-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist