Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | F1610 | TX |
NPI | 1396825659 |
---|---|
Provider Name | Imelda Celine Hanson |
First Address | Houston, TX 77030-2316 |
Second Address | Houston, TX 77030-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 14/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E75669 | (02) | |
P080029G8 | (05) | TX |