1306266028 NPI number — MRS. LAURA MINERO WHITTAKER PA-C

Table of content: MRS. LAURA MINERO WHITTAKER PA-C (NPI 1306266028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306266028 NPI number — MRS. LAURA MINERO WHITTAKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTAKER
Provider First Name:
LAURA
Provider Middle Name:
MINERO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINERO
Provider Other First Name:
LAURA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306266028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 BEECH BEND DRIVE
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:
77077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-814-0196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 FANNIN ST. CLINICAL CARE CENTER SUITE 950
Provider Second Line Business Practice Location Address:
TEXAS CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-826-1075
Provider Business Practice Location Address Fax Number:
832-825-3504
Provider Enumeration Date:
04/21/2014

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com