Healthcare Provider Details

I. General information

NPI: 1689683039
Provider Name (Legal Business Name): ANNA LISA CHAVANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LISA MARTINEZ M.D.

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 VILLAGE DR SUITE 410
SAN ANTONIO TX
78217-5405
US

IV. Provider business mailing address

1210 ARION PKWY
SAN ANTONIO TX
78216-2880
US

V. Phone/Fax

Practice location:
  • Phone: 210-653-5501
  • Fax: 210-650-5975
Mailing address:
  • Phone: 210-653-5501
  • Fax: 210-650-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK7185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: