Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K5380 | TX |
NPI | 1003844820 |
---|---|
Provider Name | Severino Pimentel |
First Address | Katy, TX 77450-7580 |
Second Address | Katy, TX 77450-7580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 12/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G87156 | (02) | TX |