Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 36459 | TX |
Y | 213EG0000X | General Practice | 36459 | TX |
NPI | 1003426255 |
---|---|
Provider Name | Jennifer Diep |
First Address | Katy, TX 77450-3515 |
Second Address | Harlingen, TX 78552-3222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2020 |
Last Update Date | 03/08/2020 |