Provider Demographics
NPI:1831711217
Name:ONTIVEROS, HUGO ALAN (RN)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:ALAN
Last Name:ONTIVEROS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N KANSAS ST STE 743
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1443
Mailing Address - Country:US
Mailing Address - Phone:915-213-1289
Mailing Address - Fax:
Practice Address - Street 1:9264 MCFALL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5144
Practice Address - Country:US
Practice Address - Phone:915-383-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX988914163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse