Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | AP142157 | TX |
NPI | 1104467562 |
---|---|
Provider Name | Selina E Tristan |
First Address | Mcallen, TX 78504-6112 |
Second Address | Mcallen, TX 78504-6112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 07/10/2019 |