Provider Demographics
NPI:1952006785
Name:ROSA ORTIZ, MAITE (FNP)
Entity Type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:ROSA ORTIZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 BINGLE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1009
Mailing Address - Country:US
Mailing Address - Phone:832-742-8135
Mailing Address - Fax:832-742-8148
Practice Address - Street 1:2973 BINGLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1009
Practice Address - Country:US
Practice Address - Phone:832-742-8135
Practice Address - Fax:832-742-8148
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily