Provider Demographics
NPI:1588253223
Name:BELLEZA, MARIA OLIVIA DERUPE
Entity type:Individual
Prefix:
First Name:MARIA OLIVIA
Middle Name:DERUPE
Last Name:BELLEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 SPANISH WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6241
Mailing Address - Country:US
Mailing Address - Phone:361-290-2747
Mailing Address - Fax:
Practice Address - Street 1:7217 SPANISH WOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6241
Practice Address - Country:US
Practice Address - Phone:361-290-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1024331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily