Healthcare Provider Details

I. General information

NPI: 1154821940
Provider Name (Legal Business Name): GERALDINE MOLENDE EFOSI LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 HORIZON HILL BLVD APT 1711
SAN ANTONIO TX
78229-2240
US

IV. Provider business mailing address

4400 HORIZON HILL BLVD APT 1711
SAN ANTONIO TX
78229-2240
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-2373
  • Fax: 240-705-2373
Mailing address:
  • Phone: 240-705-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number332716
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: