Healthcare Provider Details

I. General information

NPI: 1558650226
Provider Name (Legal Business Name): RASIEL MATOS SARDINA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 KATY FWY STE 101
HOUSTON TX
77043-5269
US

IV. Provider business mailing address

PO BOX 38450
HOUSTON TX
77238-8450
US

V. Phone/Fax

Practice location:
  • Phone: 346-571-7500
  • Fax: 713-492-2440
Mailing address:
  • Phone: 832-461-9413
  • Fax: 281-890-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number1003131
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003131
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: