Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | BP10030553 | TX |
Y | 2080P0202X | Pediatric Cardiologist | P0340 | TX |
NPI | 1245526649 |
---|---|
Provider Name | Maria Bano |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 30/09/2015 |