Provider Demographics
NPI:1114353364
Name:ORMENO, ERICA JANE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:ORMENO
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 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3711
Mailing Address - Fax:210-271-7208
Practice Address - Street 1:1034 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-8338
Practice Address - Country:US
Practice Address - Phone:830-606-9900
Practice Address - Fax:830-608-1073
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328740101Medicaid
TX330334YMR2Medicare PIN