Individual
KELLI MASK MAMADALIYEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
333 N SANTA ROSA ST, SAN ANTONIO, TX 78207-3108
(210) 704-4038
(210) 704-4520
Mailing address
333 N SANTA ROSA ST, SAN ANTONIO, TX 78207-3108
(210) 704-4038
(210) 704-4520
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
720441
TX
Other
Enumeration date
09/30/2013
Last updated
10/07/2021
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