MEDICARE: LUZ MARINA VIALE FNP

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	363LF0000X	Family Nurse Practitioner	1061197	TX

General Provider Information

NPI Number	:	1760134019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ MARINA VIALE FNP

Provider Business Mailing Address
First Line	:	5016 E FM 1518 N
Second Line	:
City	:	SELMA
State	:	TX
Zip	:	78154-1360
Country	:	US
Telephone Number	:	210-654-9300
Fax Number	:	210-654-9302

Provider Business Practice Location Address
First Line	:	5016 E FM 1518 N
Second Line	:
City	:	SELMA
State	:	TX
Zip	:	78154-1360
Country	:	US
Telephone Number	:	210-654-9300
Fax Number	:	210-654-9302

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

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	06/27/2023

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Directions to “ LUZ MARINA VIALE FNP” Practice Location

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