Provider Demographics
NPI:1396799847
Name:LEPE SUASTEGUI, MARIA RITA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:RITA
Last Name:LEPE SUASTEGUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-345-5634
Mailing Address - Fax:214-648-4131
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4402
Practice Address - Country:US
Practice Address - Phone:214-645-0595
Practice Address - Fax:214-648-4131
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9316207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166783401Medicaid
TX166783402Medicaid
TX8P0441OtherBCBS
TXP00297334Medicare PIN
TX166783402Medicaid
TX8C1706Medicare PIN
TX8G5969Medicare PIN
TXI13367Medicare UPIN