Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 49464 | MN |
Y | 207YP0228X | Pediatric Otolaryngology | M9720 | TX |
NPI | 1700088739 |
---|---|
Provider Name | Ronald Jason Vilela |
First Address | Houston, TX 77030-2610 |
Second Address | Houston, TX 77030-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 31/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207261301 | (05) | TX |
8L13895 | MEDICARE PTAN (01) |