Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | Q3720 | TX |
NPI | 1003170614 |
---|---|
Provider Name | Patricia May B. Lacsina |
First Address | Dallas, TX 75373-4812 |
Second Address | San Antonio, TX 78207-0903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 25/05/2021 |