Provider Demographics
NPI:1982015368
Name:MEDINA, MARIA ROSALBA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROSALBA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ROSALBA
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:7514 FOUNTAINCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-1849
Mailing Address - Country:US
Mailing Address - Phone:713-504-5721
Mailing Address - Fax:
Practice Address - Street 1:21216 NORTHWEST FWY
Practice Address - Street 2:SUITE 440
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1439
Practice Address - Country:US
Practice Address - Phone:713-504-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse