Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 580808 | TX |
NPI | 1265859755 |
---|---|
Provider Name | Dr. Peace Dorothy Imani |
First Address | Houston, TX 77030-2619 |
Second Address | Houston, Tx, TX 77030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 30/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265859755 | (05) | TX |