Provider Demographics
NPI:1851990931
Name:ONTIBEROS, SENECAE PATRICE
Entity Type:Individual
Prefix:
First Name:SENECAE
Middle Name:PATRICE
Last Name:ONTIBEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 BADLANDS DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5039
Mailing Address - Country:US
Mailing Address - Phone:512-680-0017
Mailing Address - Fax:
Practice Address - Street 1:1119 BADLANDS DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5039
Practice Address - Country:US
Practice Address - Phone:512-680-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily