Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | T53-2021 | TX |
Y | 222Z00000X | Podiatrist | T53-2021 | TX |
NPI | 1043880800 |
---|---|
Provider Name | Mai Thi Huynh Pham |
First Address | Houston, TX 77082-2439 |
Second Address | Houston, TX 77082-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2021 |
Last Update Date | 24/06/2021 |