Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | N7213 | TX |
NPI | 1003121245 |
---|---|
Provider Name | Alejandra C Ayestaran Cassani |
First Address | San Angelo, TX 76904-6831 |
Second Address | San Angelo, TX 76904-6831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2010 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
283015001 | (05) | TX |