Healthcare Provider Details

I. General information

NPI: 1346099108
Provider Name (Legal Business Name): ESTRELLA PAMERON OFQUILA APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

V. Phone/Fax

Practice location:
  • Phone: 832-632-6500
  • Fax:
Mailing address:
  • Phone: 832-632-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1154862
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: