Provider Demographics
NPI:1356065320
Name:HORTELANO CUBILLAS, MARY JANE (CNP)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:HORTELANO CUBILLAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 W CHAPIN ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2316
Mailing Address - Country:US
Mailing Address - Phone:956-429-1134
Mailing Address - Fax:
Practice Address - Street 1:122 W CHAMPION ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4429
Practice Address - Country:US
Practice Address - Phone:195-628-7120
Practice Address - Fax:956-287-1292
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076370363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA