MEDICARE: PURAALMA DINGAL LABIS 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	363L00000X	Nurse Practitioner	1114793	TX

General Provider Information

NPI Number	:	1770351744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PURAALMA DINGAL LABIS FNP

Provider Business Mailing Address
First Line	:	20503 CREEK RIV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2083
Country	:	US
Telephone Number	:	410-537-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 W LOOP 1604 N STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3963
Country	:	US
Telephone Number	:	210-681-6176
Fax Number	:	210-681-6157

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	09/24/2025

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