Healthcare Provider Details

I. General information

NPI: 1932964483
Provider Name (Legal Business Name): ELIANE ALUMNIKANANA FRUEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 GARDEN AVE # 1728
FORT SAM HOUSTON TX
78234-7718
US

IV. Provider business mailing address

1811 ARMY BLVD
FORT SAM HOUSTON TX
78234-2686
US

V. Phone/Fax

Practice location:
  • Phone: 210-683-3265
  • Fax:
Mailing address:
  • Phone: 210-683-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: