Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | L7301 | TX |
NPI | 1063445260 |
---|---|
Provider Name | Iliana Amaya Grever |
First Address | Webster, TX 77598-4043 |
Second Address | San Antonio, TX 78232-2679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 16/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127640 | (02) | TX |
172833902 | (05) | TX |