Provider Demographics
NPI:1215459565
Name:REQUENEZ, RICARDO J (NP)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:REQUENEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4188
Mailing Address - Country:US
Mailing Address - Phone:361-664-4445
Mailing Address - Fax:361-664-4449
Practice Address - Street 1:2510 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4188
Practice Address - Country:US
Practice Address - Phone:361-664-4445
Practice Address - Fax:361-664-4449
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP134359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily