Provider Demographics
NPI:1699160150
Name:ONTIVEROS LOYA, BIANCA M (NP)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:M
Last Name:ONTIVEROS LOYA
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Gender:F
Credentials:NP
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Mailing Address - Street 1:7430 REMCON CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3514
Mailing Address - Country:US
Mailing Address - Phone:915-584-0051
Mailing Address - Fax:915-833-1114
Practice Address - Street 1:7430 REMCON CIR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3514
Practice Address - Country:US
Practice Address - Phone:915-584-0051
Practice Address - Fax:915-833-1114
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-10-27
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Provider Licenses
StateLicense IDTaxonomies
TXAP127763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409091YLPSOtherWELLMED PTAN
TX348780301Medicaid