Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | J1651 | TX |
NPI | 1104986553 |
---|---|
Provider Name | Ms. Concepcion Ravelo Diaz-Arrastia |
First Address | Houston, TX 77004-7083 |
Second Address | Houston, TX 77004-7083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124926003 | (05) | TX |
F41574 | (02) | TX |