=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215971882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIAN M AYOUB M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 12/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18414 US HIGHWAY 281 N SUITE 116
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78259-7610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-354-0800
-----------------------------------------------------
Fax | 210-598-7876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 NAVARRO ST SUITE 200
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78205-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-354-0800
-----------------------------------------------------
Fax | 210-598-7876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L7742
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------