Provider Demographics
NPI:1801499397
Name:TROBAJO CASIN, MARA (F06240472)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:TROBAJO CASIN
Suffix:
Gender:F
Credentials:F06240472
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3117
Mailing Address - Country:US
Mailing Address - Phone:832-871-4777
Mailing Address - Fax:
Practice Address - Street 1:20023 MILLSTONE RIDGE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5336
Practice Address - Country:US
Practice Address - Phone:786-326-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily