Basic Information
Provider Information | |||||||||
NPI: | 1679682223 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | XAVIER | ||||||||
FirstName: | ANDREEA | ||||||||
MiddleName: | SIMONA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | POPOVICI | ||||||||
OtherFirstName: | ANDREEA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6431 FANNIN JJL 270A | ||||||||
Address2: | JJL 270A | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 77030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7137049389 | ||||||||
FaxNumber: | 4349827752 | ||||||||
Practice Location | |||||||||
Address1: | 6431 FANNIN JJL 270A | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770307703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5853225736 | ||||||||
FaxNumber: | 4349827581 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/29/2006 | ||||||||
LastUpdateDate: | 11/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101244083 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 0101244083 | VA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 02868477 | 05 | NY |   | MEDICAID |