Provider Demographics
NPI:1578597423
Name:STAWOWY, LALA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALA
Middle Name:MARIA
Last Name:STAWOWY
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 1:9150 HUEBNER RD.
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1540
Mailing Address - Country:US
Mailing Address - Phone:210-692-7684
Mailing Address - Fax:210-692-1814
Practice Address - Street 1:9150 HUEBNER RD.
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1545
Practice Address - Country:US
Practice Address - Phone:210-692-7684
Practice Address - Fax:210-692-1814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1533207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1233017-02Medicaid
TX1233017-01Medicaid
TXQI79Medicare ID - Type UnspecifiedSAN ANTONIO LOCATION
TXL84KMedicare ID - Type UnspecifiedKERRVILLE LOCATION
TXC22201Medicare UPIN