Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | K5233 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | K5233 | TX |
NPI | 1144300484 |
---|---|
Provider Name | George Nikita Vailas |
First Address | Pearland, TX 77584-8204 |
Second Address | Pearland, TX 77584-8204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 18/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49112 | (02) |