Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | M0614 | TX |
NPI | 1083675359 |
---|---|
Provider Name | Omar A Zantua |
First Address | Houston, TX 77075-4857 |
Second Address | Houston, TX 77075-4857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 04/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173870002 | (05) | TX |
H63938 | (02) | TX |