Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 12278 | TX |
NPI | 1316381247 |
---|---|
Provider Name | Dr. Reece Maricelli Hayden |
First Address | Houston, TX 77065-4238 |
Second Address | Houston, TX 77065-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 22/04/2013 |