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General NPI Number Information
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NPI Number | 1093372955
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Entity Type | Individual
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Provider Name | GREMAR CORPUZ
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Gender | Male
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 1500 RED RIVER ST
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City | AUSTIN
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State | TX
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Zip | 78701-1918
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Country | US
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Telephone | 512-324-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 20709 SONG BIRD DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-7881
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Country | US
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Telephone | 512-944-5238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | AP137629
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License Number State | TX
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