Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | N2740 | TX |
NPI | 1003020504 |
---|---|
Provider Name | Tricia Punsalan |
First Address | Conroe, TX 77304-2808 |
Second Address | Conroe, TX 77301-2740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 05/07/2016 |