Provider Demographics
NPI:1508344516
Name:BERONGOY, MA FE VICENTA (RN)
Entity Type:Individual
Prefix:
First Name:MA FE VICENTA
Middle Name:
Last Name:BERONGOY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25126 CLOVER RANCH DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3016
Mailing Address - Country:US
Mailing Address - Phone:702-321-7427
Mailing Address - Fax:
Practice Address - Street 1:16439 RODEO RIVER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1978
Practice Address - Country:US
Practice Address - Phone:713-542-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX749176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse