MEDICARE: AURAVIA WELLNESS LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164200283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURAVIA WELLNESS LLC

Provider Business Mailing Address
First Line	:	14701 SAN PEDRO AVE STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-858-6127
Fax Number	:	210-485-1062

Provider Business Practice Location Address
First Line	:	14701 SAN PEDRO AVE STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-858-6127
Fax Number	:	210-485-1062

Authorized Official
Title or Position	:	OWNER
Name	:	JEANETTE LIRA
Credential	:	LPC-S
Telephone Number	:	210-858-6127

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/28/2023

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Directions to “AURAVIA WELLNESS LLC ” Practice Location

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