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NPI Code Detail

MEDICARE: YANNETH GUADALUPE LONGORIA WHNP

MEDICARE: YANNETH GUADALUPE LONGORIA WHNP
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
1363LW0102XWomen's Health Nurse PractitionerNP258638GA

General Provider Information

NPI Number : 1235852864
Entity Type Code : Individual
Provider Name (Legal Business Name) : YANNETH GUADALUPE LONGORIA WHNP
Provider Business Mailing Address
First Line : 221 3RD ST W BLDG 1040
Second Line :
City : UNIVERSAL CITY
State : TX
Zip : 78150-4800
Country : US
Telephone Number : 210-652-3506
Fax Number :
Provider Business Practice Location Address
First Line : 221 3RD ST W BLDG 1040
Second Line : LACKLAND MEDICAL SQUADRON-RANDOLPH
City : UNIVERSAL CITY
State : TX
Zip : 78150-4800
Country : US
Telephone Number : 210-652-1836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2022
Last Update Date : 12/04/2025

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