MEDICARE: CRYSTAL LOUISE UGARTE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP126838	TX

General Provider Information

NPI Number	:	1932599784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LOUISE UGARTE FNP-C

Provider Business Mailing Address
First Line	:	3701 KIRBY DR STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3926
Country	:	US
Telephone Number	:	713-798-7748
Fax Number	:	713-798-2725

Provider Business Practice Location Address
First Line	:	1623 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-3607
Country	:	US
Telephone Number	:	713-218-2697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	11/15/2024

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