Provider Demographics
NPI:1093144560
Name:ANAYA, MARIBEL (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:ANAYA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4902
Mailing Address - Country:US
Mailing Address - Phone:713-239-1572
Mailing Address - Fax:713-239-1577
Practice Address - Street 1:5402 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4902
Practice Address - Country:US
Practice Address - Phone:713-239-1572
Practice Address - Fax:713-239-1577
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346814YXEWMedicare PIN