Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 31889 | TX |
N | 103T00000X | Psychologist | 31889 | TX |
Y | 103TH0100X | Health Service | 31889 | TX |
NPI | 1326110362 |
---|---|
Provider Name | Dr. Antonia Lisa Guerra-Watson |
First Address | Grapevine, TX 76051-8145 |
Second Address | Grapevine, TX 76051-8145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2021 |