Provider Demographics
NPI:1659053205
Name:NORIEGA, SUSIE (DST TRANSPORTATION)
Entity Type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:DST TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 FM1960 RD E
Mailing Address - Street 2:PMB 141
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346
Mailing Address - Country:US
Mailing Address - Phone:281-804-6098
Mailing Address - Fax:
Practice Address - Street 1:19702 OAK GREEN CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1215
Practice Address - Country:US
Practice Address - Phone:281-804-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10065618343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)