Individual
MRS. KATHRYN ROSE TABLIZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3851 ROGER BROOKE DR, MCHE-QD (CREDENTIALS), FORT SAM HOUSTON, TX 78234
(210) 916-1222
Mailing address
11126 ELK PARK, SAN ANTONIO, TX 78249-4243
(210) 694-4558
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
644585
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP108879
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002179206
—
TX
01
—
002179207
CSHCN
TX
Enumeration date
11/07/2005
Last updated
08/13/2018
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