Provider Demographics
NPI:1083126668
Name:GOROSPE-YADAO, EDRALIN EMILY
Entity Type:Individual
Prefix:MRS
First Name:EDRALIN
Middle Name:EMILY
Last Name:GOROSPE-YADAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16111 SALTO DEL AGUA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3378
Mailing Address - Country:US
Mailing Address - Phone:210-862-3269
Mailing Address - Fax:
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?:Yes
Enumeration Date:2017-11-03
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135717363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care