MEDICARE: YAMISEL ORTEGA HERRERA

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	163W00000X	Registered Nurse	963114	TX
2	363LF0000X	Family Nurse Practitioner	1109026	TX

General Provider Information

NPI Number	:	1447891189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMISEL ORTEGA HERRERA

Provider Business Mailing Address
First Line	:	18511 KINGS LYNN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3219
Country	:	US
Telephone Number	:	786-307-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	18511 KINGS LYNN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3219
Country	:	US
Telephone Number	:	786-307-6458
Fax Number	:

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

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	05/09/2023

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Directions to “ YAMISEL ORTEGA HERRERA ” Practice Location

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