Individual
JARRED ALICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 WALLER ST, AUSTIN, TX 78702-5240
(512) 972-5460
Mailing address
217 BRIARCLIFF DR, SAN ANTONIO, TX 78213-1936
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
GMR02011530
TX
247100000X
Radiologic Technologist
Primary
GMR02011530
TX
Other
Enumeration date
05/14/2026
Last updated
05/26/2026
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