Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 23226 | TX |
NPI | 1003093410 |
---|---|
Provider Name | Dr. Alia Chakaki |
First Address | San Antonio, TX 78221-1535 |
Second Address | Houston, TX 77070-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 08/11/2011 |