Provider Demographics
NPI:1679801203
Name:ORELLANA, LOURDES MARGARITA (PA-C)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:MARGARITA
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RIVERWOOD CT STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2973
Mailing Address - Country:US
Mailing Address - Phone:936-441-2012
Mailing Address - Fax:936-494-4012
Practice Address - Street 1:1020 RIVERWOOD CT STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2973
Practice Address - Country:US
Practice Address - Phone:936-441-2012
Practice Address - Fax:936-494-4012
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant