Provider Demographics
NPI:1801372263
Name:MATHURIN, IRVING
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:
Last Name:MATHURIN
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 1:906 TENNESSEE TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6400
Mailing Address - Country:US
Mailing Address - Phone:347-424-9533
Mailing Address - Fax:
Practice Address - Street 1:906 TENNESSEE TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6400
Practice Address - Country:US
Practice Address - Phone:347-424-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307825164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse