Provider Demographics
NPI:1669651725
Name:JUSTO, ANALIZA TENIDO (MD)
Entity Type:Individual
Prefix:
First Name:ANALIZA
Middle Name:TENIDO
Last Name:JUSTO
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 1:403 OGLETREE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9444
Mailing Address - Country:US
Mailing Address - Phone:936-327-5686
Mailing Address - Fax:936-327-9211
Practice Address - Street 1:403 OGLETREE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-327-5686
Practice Address - Fax:936-327-9211
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1089207V00000X
IN01066966A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354643401Medicaid
TX354643401Medicaid