Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 28449 | TX |
Y | 213EG0000X | General Practice | 28449 | TX |
NPI | 1003150384 |
---|---|
Provider Name | Dr. Marella Jo Tagatac |
First Address | Houston, TX 77025-2940 |
Second Address | Houston, TX 77025-2940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |