Provider Demographics
NPI:1255680088
Name:REAL, MARIA ISABEL DEL PUERTO (NP)
Entity type:Individual
Prefix:MRS
First Name:MARIA ISABEL
Middle Name:DEL PUERTO
Last Name:REAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:REAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:7617 MISTY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7537
Mailing Address - Country:US
Mailing Address - Phone:281-692-6300
Mailing Address - Fax:
Practice Address - Street 1:7617 MISTY LAKE LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7537
Practice Address - Country:US
Practice Address - Phone:281-692-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00387200363LA2200X
TX617190363LA2200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse