Provider Demographics
NPI:1982141404
Name:MAULAZ MCGOUGH, ALINE NAYARA
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:NAYARA
Last Name:MAULAZ MCGOUGH
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 1:22110 YORKHAVEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2138
Mailing Address - Country:US
Mailing Address - Phone:830-928-3110
Mailing Address - Fax:
Practice Address - Street 1:22110 YORKHAVEN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2138
Practice Address - Country:US
Practice Address - Phone:830-928-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXABSA #16-625246ZC0007X
ZZCOREN-GO 232.388163W00000X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse