Basic Information
Provider Information
NPI: 1134561368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURNS
FirstName: HALYA
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3750 COMMERCIAL AVE
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782213117
CountryCode: US
TelephoneNumber: 2103343700
FaxNumber: 2109220162
Practice Location
Address1: 5542 WALZEM RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 78218
CountryCode: US
TelephoneNumber: 2106342480
FaxNumber: 2106372484
Other Information
ProviderEnumerationDate: 07/30/2013
LastUpdateDate: 08/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X18358TXY Dental ProvidersDental Hygienist 

No ID Information.


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