Provider Demographics
NPI:1477559821
Name:ERES, MARIO CRISTOBAL (FNP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:CRISTOBAL
Last Name:ERES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:8600 BATAAN MEMORIAL EAST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6016
Practice Address - Country:US
Practice Address - Phone:575-373-9202
Practice Address - Fax:575-373-9592
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109728363LF0000X
NMR33416363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS9732Medicaid
NMP11943Medicare UPIN
NMS9732Medicaid