Provider Demographics
NPI:1609842178
Name:DERESKA, NINA H (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:H
Last Name:DERESKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W. GRAND PARKWAY S.
Mailing Address - Street 2:SUITE #500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:713-486-1250
Mailing Address - Fax:832-945-3159
Practice Address - Street 1:17510 W. GRAND PARKWAY S.
Practice Address - Street 2:SUITE #500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:713-486-1530
Practice Address - Fax:832-759-5904
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0371207VF0040X
IN01067358A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010185C19Medicare PIN
VA10255643Medicaid
VA010255660Medicaid
VA010255627Medicaid
VAH60829Medicare UPIN