Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1308587 | TX |
Y | 213ES0000X | Sports Medicine | 1308587 | TX |
NPI | 1396213856 |
---|---|
Provider Name | Kayla Panos |
First Address | Houston, TX 77008-2672 |
Second Address | Conroe, TX 77384-5148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 02/11/2018 |