Provider Demographics
NPI:1427053503
Name:DE LOS SANTOS, MARIA ANNABELLE T (FNP)
Entity type:Individual
Prefix:
First Name:MARIA ANNABELLE
Middle Name:T
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:
Other - Last Name:AGAPITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:12141 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2408
Mailing Address - Country:US
Mailing Address - Phone:281-588-8110
Mailing Address - Fax:
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2408
Practice Address - Country:US
Practice Address - Phone:281-588-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1623894-01Medicaid
TX1623894-01Medicaid
TX8B2721Medicare ID - Type Unspecified