Provider Demographics
NPI:1962622159
Name:GRIFFIN, VIOLETA VANESSA (MD)
Entity type:Individual
Prefix:DR
First Name:VIOLETA
Middle Name:VANESSA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:VIOLETA
Other - Middle Name:VANESSA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:151 EXCHANGE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5381
Practice Address - Country:US
Practice Address - Phone:512-846-1244
Practice Address - Fax:512-846-1963
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186941407Medicaid
TX186941408Medicaid
TX317760YKXVMedicare PIN
TX186941408Medicaid