Provider Demographics
NPI:1366546731
Name:KIPRONO, LUISSA V (DO)
Entity type:Individual
Prefix:DR
First Name:LUISSA
Middle Name:V
Last Name:KIPRONO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LUISSA
Other - Middle Name:V
Other - Last Name:FISTEAG-KIPRONO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:17511 RANCHO DIANA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3366
Mailing Address - Country:US
Mailing Address - Phone:210-660-9906
Mailing Address - Fax:
Practice Address - Street 1:17511 RANCHO DIANA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3366
Practice Address - Country:US
Practice Address - Phone:210-660-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023009165207VM0101X
IN02002686A207VM0101X
NE1889207VM0101X
OH34.013544207VM0101X
TXR9995207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty