Basic Information
| Provider Information | |||||||||
| NPI: | 1003891110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARENTE | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | TAVARES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 CENTRAL PKWY S STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105906195 | ||||||||
| FaxNumber: | 2106505993 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 MADISON OAK DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104951900 | ||||||||
| FaxNumber: | 2106505975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 12899 | HI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | P0651 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 287688003 | 05 | TX | MEDICAID |