Provider Demographics
NPI:1477102028
Name:FERNANDEZ-PLATA, URSULA EILEEN
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:EILEEN
Last Name:FERNANDEZ-PLATA
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:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-0926
Mailing Address - Country:US
Mailing Address - Phone:832-767-8621
Mailing Address - Fax:
Practice Address - Street 1:1221 CR 4371
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:832-767-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty