Provider Demographics
NPI:1306382635
Name:JIWANI, ROZMIN B (PHD)
Entity type:Individual
Prefix:
First Name:ROZMIN
Middle Name:B
Last Name:JIWANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21935 KENTON CROFT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7840
Mailing Address - Country:US
Mailing Address - Phone:210-639-0398
Mailing Address - Fax:
Practice Address - Street 1:21935 KENTON CROFTS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7840
Practice Address - Country:US
Practice Address - Phone:210-639-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639678163W00000X
TXAP118312364SA2200X, 405300000X
TXRX. AUTH: 9650364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No405300000XOther Service ProvidersPrevention Professional