Provider Demographics
NPI:1215113519
Name:VEN HUIZEN, VANESSA (DO)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VEN HUIZEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 ROUND ROCK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4215
Mailing Address - Country:US
Mailing Address - Phone:512-388-9495
Mailing Address - Fax:512-716-0371
Practice Address - Street 1:1750 ROUND ROCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4215
Practice Address - Country:US
Practice Address - Phone:512-388-9495
Practice Address - Fax:512-716-0371
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193288102Medicaid
TX193288103Medicaid
TXTXB152526Medicare PIN
TX193288103Medicaid