Provider Demographics
NPI:1174247779
Name:ARRIETA WAMBRUG, LEYVIS
Entity type:Individual
Prefix:
First Name:LEYVIS
Middle Name:
Last Name:ARRIETA WAMBRUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19321 PARK ROW APT 1429
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4893
Mailing Address - Country:US
Mailing Address - Phone:813-836-3590
Mailing Address - Fax:
Practice Address - Street 1:19321 PARK ROW APT 1429
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4893
Practice Address - Country:US
Practice Address - Phone:813-836-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000137363LF0000X
FL11021726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily