Provider Demographics
NPI:1255372173
Name:DELOSSANTOS, OLIVA DINAL (ANP/GNP)
Entity type:Individual
Prefix:MRS
First Name:OLIVA
Middle Name:DINAL
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:ANP/GNP
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:DINAL
Other - Last Name:DELOSSANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP/GNP
Mailing Address - Street 1:2 E GREENWAY PLZ
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1835
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:5D OFFICE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505772363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165583902Medicaid
P83762Medicare UPIN
TX165583902Medicaid