1184785271 NPI number — MRS. HELEN LIZA ALFRED P.T., A.T.P.

Table of content: JIWON PARK (NPI 1871265827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184785271 NPI number — MRS. HELEN LIZA ALFRED P.T., A.T.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALFRED
Provider First Name:
HELEN
Provider Middle Name:
LIZA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T., A.T.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANLAS
Provider Other First Name:
HELEN
Provider Other Middle Name:
LIZA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT., ATP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184785271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12618 TALLWOOD CROSSING
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:
77041-7253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-983-7027
Provider Business Mailing Address Fax Number:
713-983-7027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8021 BISSONNET ST
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:
77074-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-774-5437
Provider Business Practice Location Address Fax Number:
713-774-5445
Provider Enumeration Date:
12/12/2006

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: 225100000X , with the licence number:  1140895 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251P0200X , with the licence number: 1140895 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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