=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659921377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSIRIS YAQUELIN PAZ CRUZ NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2019
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 388 W LITTLE YORK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77076-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-207-3170
-----------------------------------------------------
Fax | 877-872-7884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 388 W LITTLE YORK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77076-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-207-3170
-----------------------------------------------------
Fax | 877-370-2120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | AP143049
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP143049
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------