Provider Demographics
NPI:1821824228
Name:NEVAREZ, GRETTA ESTEFANIA (QMHP-CS)
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:ESTEFANIA
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3504
Mailing Address - Country:US
Mailing Address - Phone:915-286-6370
Mailing Address - Fax:
Practice Address - Street 1:1714 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3504
Practice Address - Country:US
Practice Address - Phone:915-286-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker