Provider Demographics
NPI:1558650226
Name:MATOS SARDINA, RASIEL (CNP)
Entity Type:Individual
Prefix:
First Name:RASIEL
Middle Name:
Last Name:MATOS SARDINA
Suffix:
Gender:M
Credentials:CNP
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 38450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8450
Mailing Address - Country:US
Mailing Address - Phone:832-461-9413
Mailing Address - Fax:281-890-8938
Practice Address - Street 1:10496 KATY FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5269
Practice Address - Country:US
Practice Address - Phone:346-571-7500
Practice Address - Fax:713-492-2440
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003131163WX0800X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Single Specialty