Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R1165 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | R1165 | TX |
NPI | 1235445735 |
---|---|
Provider Name | Dr. Gnana Dheepa Ardhanari |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2010 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380330601 | (05) | TX |
380330602 | CSHCN (01) | TX |