Provider Demographics
NPI:1003409764
Name:VASTANI, ALMINA (AGACNP)
Entity Type:Individual
Prefix:MISS
First Name:ALMINA
Middle Name:
Last Name:VASTANI
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MISS
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:VASTANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGACNP
Mailing Address - Street 1:19950 HUEBNER RD APT 1810
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3500
Mailing Address - Country:US
Mailing Address - Phone:310-497-5541
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:310-358-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030118363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care