MEDICARE: JAWUN JILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	207210	LA
2	367500000X	Certified Registered Nurse Anesthetist	1188698	TX

General Provider Information

NPI Number	:	1043087075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWUN JILES

Provider Business Mailing Address
First Line	:	18111 LA CANTERA TER APT 1102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2674
Country	:	US
Telephone Number	:	318-564-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	18111 LA CANTERA TER APT 1102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2674
Country	:	US
Telephone Number	:	318-564-4197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	01/22/2025

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Directions to “ JAWUN JILES ” Practice Location

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