Provider Demographics
NPI:1780184747
Name:BERAUN, NILO ENRIQUE
Entity Type:Individual
Prefix:
First Name:NILO
Middle Name:ENRIQUE
Last Name:BERAUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19218 STANTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4093
Mailing Address - Country:US
Mailing Address - Phone:908-240-8565
Mailing Address - Fax:
Practice Address - Street 1:3315 MARQUART ST STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6027
Practice Address - Country:US
Practice Address - Phone:713-799-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203748164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse