Provider Demographics
NPI:1316497985
Name:WAFFUL, LORALYN (PA-C)
Entity type:Individual
Prefix:
First Name:LORALYN
Middle Name:
Last Name:WAFFUL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORALYN
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3320 OAKWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3128
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:
Practice Address - Street 1:3320 OAKWELL CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3128
Practice Address - Country:US
Practice Address - Phone:210-829-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84288133V00000X
TXPA16989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered