Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | K4661 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | K4661 | TX |
NPI | 1104863745 |
---|---|
Provider Name | Andrew B Civitello |
First Address | Houston, TX 77004-6900 |
Second Address | Houston, TX 77004-6900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 13/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038749003 | (05) | TX |
G77873 | (02) | TX |