Provider Demographics
NPI:1821083825
Name:MADRIZ, IRENE M (CRNA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:MADRIZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 203057
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-3057
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:8850 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3006
Practice Address - Country:US
Practice Address - Phone:713-827-1820
Practice Address - Fax:713-468-7370
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050593OtherRECERTIFICATION AANA
TX81800UOtherBLUE CROSS BLUE SHIELD
TX002976101Medicaid
TX430055436Medicare ID - Type UnspecifiedRAILROAD
TX81800UOtherBLUE CROSS BLUE SHIELD
TX83900HMedicare ID - Type Unspecified