Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | S3401 | TX |
NPI | 1780945378 |
---|---|
Provider Name | Yula Alexandria Indeyeva |
First Address | Austin, TX 78735-9000 |
Second Address | Austin, TX 78735-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 17/11/2020 |