Healthcare Provider Details

I. General information

NPI: 1659112704
Provider Name (Legal Business Name): NAOMI GABRIELLE LANOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 KYLE PKWY
KYLE TX
78640-6112
US

IV. Provider business mailing address

1515 S LAMAR BLVD APT 1117
AUSTIN TX
78704-2969
US

V. Phone/Fax

Practice location:
  • Phone: 512-504-5000
  • Fax:
Mailing address:
  • Phone: 571-268-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number324420
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: