Healthcare Provider Details

I. General information

NPI: 1689219909
Provider Name (Legal Business Name): MEAZA ABAY GEBRU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 ADA ST
SAN ANTONIO TX
78223-1703
US

IV. Provider business mailing address

12270 HUNTINGTON VENTURE DR
HOUSTON TX
77099-3802
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-5515
  • Fax:
Mailing address:
  • Phone: 832-482-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: