Provider Demographics
NPI:1912412537
Name:MATHEW, BIJU (FNP)
Entity Type:Individual
Prefix:
First Name:BIJU
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 BANDERA RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5616
Mailing Address - Country:US
Mailing Address - Phone:210-450-6530
Mailing Address - Fax:210-450-2140
Practice Address - Street 1:10350 BANDERA RD STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5616
Practice Address - Country:US
Practice Address - Phone:210-450-6530
Practice Address - Fax:210-450-2140
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381634003Medicaid
TX381634004OtherCSHCN