Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | BP10034312 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | P5713 | TX |
NPI | 1114272994 |
---|---|
Provider Name | Dr. Diana Racusin |
First Address | Houston, TX 77030-3000 |
Second Address | Houston, TX 77030-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 28/11/2016 |