1548930894 NPI number — DR. CARLY ELENA ANTOINETTE BARBON PHD

Table of content: DR. CARLY ELENA ANTOINETTE BARBON PHD (NPI 1548930894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548930894 NPI number — DR. CARLY ELENA ANTOINETTE BARBON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBON
Provider First Name:
CARLY
Provider Middle Name:
ELENA ANTOINETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1548930894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4310 DUNLAVY ST APT 256
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:
77006-5297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-208-2004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 HOLCOMBE BLVD.
Provider Second Line Business Practice Location Address:
HEAD & NECK CENTER, 10TH FL MAIN BUILDING
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-208-2004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2021

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: 235Z00000X , with the licence number:  118967 , 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)





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