Provider Demographics
NPI:1306417985
Name:VENECIA, BIANCA KARINA (PA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:KARINA
Last Name:VENECIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:GRULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78548-0208
Mailing Address - Country:US
Mailing Address - Phone:956-984-8894
Mailing Address - Fax:
Practice Address - Street 1:3626 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3643
Practice Address - Country:US
Practice Address - Phone:972-256-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant