MEDICARE: MARIAH GIRARD

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	1025340	TX

General Provider Information

NPI Number	:	1861173098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH GIRARD

Provider Business Mailing Address
First Line	:	2130 NE INTERSTATE 410 LOOP # 325
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-4208
Country	:	US
Telephone Number	:	210-653-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 NE INTERSTATE 410 LOOP # 325
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-4208
Country	:	US
Telephone Number	:	210-653-2693
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	04/25/2024

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Directions to “ MARIAH GIRARD ” Practice Location

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