Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | L9511 | TX |
NPI | 1063400406 |
---|---|
Provider Name | Luigi Terminella |
First Address | Webster, TX 77598-8538 |
Second Address | Webster, TX 77598-4820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170874503 | (05) | TX |
8U1164 | BCBSTX (01) | TX |
F58605 | (02) | |
P00665207 | RRMEDICARE (01) | TX |