Basic Information
| Provider Information | |||||||||
| NPI: | 1578010500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UT HEALTH SCIENCE CENTER - PEDIATRIC PULMONARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 FANNIN ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323256516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323256516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | DA COSTA - PANY | ||||||||
| AuthorizedOfficialFirstName: | CANDICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 8325335988 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP131407 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.