Provider Demographics
NPI:1134939390
Name:BUENAVENTURA, MERVIN HUERTAS
Entity type:Individual
Prefix:
First Name:MERVIN
Middle Name:HUERTAS
Last Name:BUENAVENTURA
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 1:5823 TEXAS SAGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3391
Mailing Address - Country:US
Mailing Address - Phone:713-818-9598
Mailing Address - Fax:
Practice Address - Street 1:5823 TEXAS SAGE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-3391
Practice Address - Country:US
Practice Address - Phone:713-818-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse