Provider Demographics
NPI:1508192295
Name:CIFUENTES, VERONICA PAZ (PA-C)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:PAZ
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2473
Mailing Address - Country:US
Mailing Address - Phone:612-812-7779
Mailing Address - Fax:
Practice Address - Street 1:3101 CHURCHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2717
Practice Address - Country:US
Practice Address - Phone:682-683-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10643363AM0700X
TXPA16292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant