Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | K0101 | TX |
NPI | 1083721153 |
---|---|
Provider Name | Dr. Kathy Ann Lacivita |
First Address | San Antonio, TX 78291-0087 |
Second Address | San Antonio, TX 78207-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 16/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104492702 | (05) | TX |