Provider Demographics
NPI:1679138044
Name:VILLAFUERTE MARROQUIN, MAYELA G (RN)
Entity Type:Individual
Prefix:
First Name:MAYELA
Middle Name:G
Last Name:VILLAFUERTE MARROQUIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 FOREST CENTER DR APT 710
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5282
Mailing Address - Country:US
Mailing Address - Phone:432-238-5212
Mailing Address - Fax:
Practice Address - Street 1:331 FOREST CENTER DR APT 710
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5282
Practice Address - Country:US
Practice Address - Phone:432-238-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse