Healthcare Provider Details

I. General information

NPI: 1205908449
Provider Name (Legal Business Name): SUYAPA MARIXA MALDONADO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N. FRAZIER ST. SUITE D
CONROE TX
77301-1220
US

IV. Provider business mailing address

9 GREENWAY PLZ STE 2950
HOUSTON TX
77046-0924
US

V. Phone/Fax

Practice location:
  • Phone: 936-718-4671
  • Fax: 936-494-4354
Mailing address:
  • Phone: 866-607-7334
  • Fax: 713-358-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number709589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: