1538380308 NPI number — MRS. STEPHANIE DELORYCE ASBERRY

Table of content: MRS. STEPHANIE DELORYCE ASBERRY (NPI 1538380308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538380308 NPI number — MRS. STEPHANIE DELORYCE ASBERRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASBERRY
Provider First Name:
STEPHANIE
Provider Middle Name:
DELORYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1538380308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3435 DARTMOUTH FIELD LN.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-439-3114
Provider Business Mailing Address Fax Number:
281-835-0548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8369 ALMEDA RD
Provider Second Line Business Practice Location Address:
SUITE R
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-7120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-665-0074
Provider Business Practice Location Address Fax Number:
713-665-0095
Provider Enumeration Date:
05/01/2007

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: 172A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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