Provider Demographics
NPI:1801629837
Name:MARTINEZ CANTILLO, SURELIS YOLANDA
Entity type:Individual
Prefix:
First Name:SURELIS
Middle Name:YOLANDA
Last Name:MARTINEZ CANTILLO
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 1:155 ELM FOREST LOOP
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78612-4021
Mailing Address - Country:US
Mailing Address - Phone:512-669-2418
Mailing Address - Fax:
Practice Address - Street 1:155 ELM FOREST LOOP
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-4021
Practice Address - Country:US
Practice Address - Phone:512-669-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily