Healthcare Provider Details

I. General information

NPI: 1366546731
Provider Name (Legal Business Name): LUISSA V KIPRONO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUISSA V FISTEAG-KIPRONO D.O.

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17511 RANCHO DIANA
SAN ANTONIO TX
78255-3366
US

IV. Provider business mailing address

17511 RANCHO DIANA
SAN ANTONIO TX
78255-3366
US

V. Phone/Fax

Practice location:
  • Phone: 210-660-9906
  • Fax:
Mailing address:
  • Phone: 210-660-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2023009165
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number02002686A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number1889
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number34.013544
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR9995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: