1558667311 NPI number — MELANIE GWENDOLYN KITAGAWA MD

Table of content: MELANIE GWENDOLYN KITAGAWA MD (NPI 1558667311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558667311 NPI number — MELANIE GWENDOLYN KITAGAWA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITAGAWA
Provider First Name:
MELANIE
Provider Middle Name:
GWENDOLYN
Provider Name Prefix Text:
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:
FEARING
Provider Other First Name:
MELANIE
Provider Other Middle Name:
GWENDOLYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558667311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6621 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE W6006 TEXAS CHILDRENS HOSPITAL CRITICAL CARE
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-826-6230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE W6006 TEXAS CHILDRENS HOSPITAL CRITICAL CARE
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-826-6230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2011

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: 2080P0203X , with the licence number:  P6009 , 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)