MEDICARE: ANAISA GORDILLO

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	1213059	TX

General Provider Information

NPI Number	:	1437011103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAISA GORDILLO

Provider Business Mailing Address
First Line	:	4450 E SAM HOUSTON PKWY S STE H2
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3950
Country	:	US
Telephone Number	:	713-910-7779
Fax Number	:	713-910-7760

Provider Business Practice Location Address
First Line	:	4450 E SAM HOUSTON PKWY S STE H2
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3950
Country	:	US
Telephone Number	:	713-910-7779
Fax Number	:	713-910-7760

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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