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Provider Information for 1477103588

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1477103588

Calendar   Last Updated:  2019-09-19
  Certification Date: 


Name Value
NPI 1477103588
Enumeration Date 2019-09-19
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 8722 CINNAMON CREEK DR APT 1227
SAN ANTONIO, TX 78240-4540
United States

Phone: 957-517-9539 | Fax:
View Map External Link
Primary Practice Address 8600 WURZBACH RD STE 701
SAN ANTONIO, TX 78240-4332
United States

Phone: 210-737-8090 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 164X00000X - Licensed Vocational Nurse TX 340699