Provider Demographics
NPI:1679517403
Name:CLAROS, EDITHA ABRENILLA (NP)
Entity type:Individual
Prefix:MRS
First Name:EDITHA
Middle Name:ABRENILLA
Last Name:CLAROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8269 NORTH LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4234
Mailing Address - Country:US
Mailing Address - Phone:915-591-1615
Mailing Address - Fax:915-591-2875
Practice Address - Street 1:6600 MONTANA AVE STE P
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2149
Practice Address - Country:US
Practice Address - Phone:915-671-1371
Practice Address - Fax:915-219-9022
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569803363L00000X
TXAP1113358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179836501Medicaid
TXQ69269Medicare UPIN