Provider Demographics
NPI:1447305081
Name:KOVAL, GLADYS M
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:M
Last Name:KOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:J
Other - Last Name:KOVAL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:804 MONTICELLO CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-2232
Mailing Address - Country:US
Mailing Address - Phone:210-534-9451
Mailing Address - Fax:
Practice Address - Street 1:804 MONTICELLO CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-2232
Practice Address - Country:US
Practice Address - Phone:210-534-9451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118485310400000X
TX146005311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility