1295847424 NPI number — ROBERTO GILBERTO PRESCOD CT, ASCP# 04075098

Table of content: ROBERTO GILBERTO PRESCOD CT, ASCP# 04075098 (NPI 1295847424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295847424 NPI number — ROBERTO GILBERTO PRESCOD CT, ASCP# 04075098

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESCOD
Provider First Name:
ROBERTO
Provider Middle Name:
GILBERTO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CT, ASCP# 04075098
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295847424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2014 UPLAND PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-7025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-545-1935
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 HOLCOMBE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-794-7261
Provider Business Practice Location Address Fax Number:
713-794-7657
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246QC2700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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