Provider Demographics
NPI:1063445260
Name:AMAYA GREVER, ILIANA (MD)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:AMAYA GREVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BAY AREA BLVD
Mailing Address - Street 2:SUITE #500
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4043
Mailing Address - Country:US
Mailing Address - Phone:281-554-2200
Mailing Address - Fax:281-554-5189
Practice Address - Street 1:16620 N US HIGHWAY 281 STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2679
Practice Address - Country:US
Practice Address - Phone:210-309-1405
Practice Address - Fax:210-688-4596
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7301207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172833902Medicaid
TX8G5005Medicare ID - Type UnspecifiedGERIATRIC ASSOCIATES
TX172833902Medicaid