Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC9001 | TX |
NPI | 1467593301 |
---|---|
Provider Name | Mrs. Sonja Re Callarman-Redden |
First Address | Humble, TX 77338-3922 |
Second Address | Humble, TX 77338-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
606648 | BCBS OF TX (01) | TX |