Provider Demographics
NPI:1437179777
Name:AMOR, BELLA LUZ M (CRNA)
Entity Type:Individual
Prefix:
First Name:BELLA LUZ
Middle Name:M
Last Name:AMOR
Suffix:
Gender:F
Credentials:CRNA
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 6050
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-6050
Mailing Address - Country:US
Mailing Address - Phone:956-541-1278
Mailing Address - Fax:956-541-2854
Practice Address - Street 1:1072 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9988
Practice Address - Country:US
Practice Address - Phone:956-541-1278
Practice Address - Fax:956-541-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX428197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B3269Medicare ID - Type UnspecifiedASSOCIATED WITH RIO
TXS22617Medicare UPIN