Provider Demographics
NPI:1639785355
Name:SANTOS MAZQUIARAN, ANGEL RAMON (FNP)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RAMON
Last Name:SANTOS MAZQUIARAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 FORT STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6255
Mailing Address - Country:US
Mailing Address - Phone:832-858-4407
Mailing Address - Fax:
Practice Address - Street 1:10656 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4214
Practice Address - Country:US
Practice Address - Phone:281-970-6966
Practice Address - Fax:281-970-6983
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1028775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily