1306461231 NPI number — ROSE MARIE DIRDEN LCDC

Table of content: ROSE MARIE DIRDEN LCDC (NPI 1306461231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306461231 NPI number — ROSE MARIE DIRDEN LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIRDEN
Provider First Name:
ROSE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIRDEN
Provider Other First Name:
ROSE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RMD SERVICES
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306461231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10150 VALLEY CLUB DR
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:
77078-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-441-1934
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7676 HILLMONT ST STE 201
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:
77040-6467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-462-3900
Provider Business Practice Location Address Fax Number:
713-462-3900
Provider Enumeration Date:
06/16/2020

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: 101YA0400X , with the licence number:  10787 , 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)