Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP133230 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP133230 | TX |
NPI | 1053850727 |
---|---|
Provider Name | Mrs. Maria Victoria Edquilang |
First Address | Missouri City, TX 77459-2352 |
Second Address | Friendswood, TX 77546-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2017 |
Last Update Date | 17/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81-5350678 | TAX ID (01) | TX |