Provider Demographics
NPI:1962048751
Name:SUAREZ RIVAS, MAYDELIS
Entity type:Individual
Prefix:
First Name:MAYDELIS
Middle Name:
Last Name:SUAREZ RIVAS
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 1:21223 BROOKWOOD CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2849
Mailing Address - Country:US
Mailing Address - Phone:386-205-4365
Mailing Address - Fax:
Practice Address - Street 1:21223 BROOKWOOD CRESCENT DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2849
Practice Address - Country:US
Practice Address - Phone:386-205-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979574163W00000X
TX1105207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse