Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | R6003 | TX |
NPI | 1063855377 |
---|---|
Provider Name | Judy Farias |
First Address | San Antonio, TX 78229-3400 |
Second Address | Live Oak, TX 78233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 22/06/2018 |