1548503667 NPI number — DR. REBECCA DIVERS BERENS MD

Table of content: DR. REBECCA DIVERS BERENS MD (NPI 1548503667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548503667 NPI number — DR. REBECCA DIVERS BERENS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERENS
Provider First Name:
REBECCA
Provider Middle Name:
DIVERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIVERS
Provider Other First Name:
REBECCA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548503667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5306 INKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77007-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-766-4496
Provider Business Mailing Address Fax Number:
346-388-0629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5225 KATY FWY STE 660
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:
77007-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-766-4496
Provider Business Practice Location Address Fax Number:
346-388-0629
Provider Enumeration Date:
03/27/2013

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD457153 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: R6744 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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