1013468396 NPI number — HOLISTIC DERMATOLOGY OF HOUSTON, PA

Table of content: (NPI 1013468396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013468396 NPI number — HOLISTIC DERMATOLOGY OF HOUSTON, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC DERMATOLOGY OF HOUSTON, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1013468396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2030 N LOOP FWY W
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77018-8101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-639-3376
Provider Business Mailing Address Fax Number:
888-824-9953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 N LOOP FWY W
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77018-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-639-3376
Provider Business Practice Location Address Fax Number:
888-824-9953
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
713-898-1419

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  P0022 , 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)





Copyright © 2007-2025 www.npivalidator.com