Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT198120 | PA |
N | 111NI0900X | Internist | MT198120 | PA |
N | 207R00000X | Internist | R1338 | TX |
N | 111NI0900X | Internist | R1338 | TX |
N | 207RC0200X | Critical Care Medicine | R1338 | TX |
Y | 207RP1001X | Pulmonary Disease | R1338 | TX |
NPI | 1053623512 |
---|---|
Provider Name | Dr. Bravein Amalakuhan |
First Address | San Antonio, TX 78229-3748 |
Second Address | San Antonio, TX 78229-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 31/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
368256901 | (05) | TX |