Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A11857 | CA |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | S9345 | TX |
NPI | 1619180916 |
---|---|
Provider Name | Saskia M Lytle-Vieira |
First Address | West Lake Hills, TX 78746-5284 |
Second Address | West Lake Hills, TX 78746-5284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 21/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A11857 | STATE OF CALIFORNIA (01) | CA |
S9345 | STATE LICENSE (01) | TX |