MEDICARE: ANGEL RAMON SANTOS MAZQUIARAN FNP

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	1028775	TX

General Provider Information

NPI Number	:	1639785355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL RAMON SANTOS MAZQUIARAN FNP

Provider Business Mailing Address
First Line	:	3010 FORT STOCKTON DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-6255
Country	:	US
Telephone Number	:	832-858-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	10656 JONES RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4214
Country	:	US
Telephone Number	:	281-970-6966
Fax Number	:	281-970-6983

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	02/06/2021

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