Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | L9402 | TX |
NPI | 1386714897 |
---|---|
Provider Name | Estela Odaniell |
First Address | Corpus Christi, TX 78411-1728 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165780101 | (05) | TX |
81654S | BLUE CROSS BLUE SHIELD (01) | TX |