Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | K4816 | TX |
NPI | 1013979871 |
---|---|
Provider Name | Tia Tortoriello Raymond |
First Address | Dallas, TX 75230-2571 |
Second Address | Dallas, TX 75230-2571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159169501 | (05) | TX |
159169504 | (05) | TX |
P00729257 | RAILROAD MEDICARE PTAN (01) | TX |