1619797230 NPI number — MYLIN WENDY HALE RCP/RRT

Table of content: MYLIN WENDY HALE RCP/RRT (NPI 1619797230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619797230 NPI number — MYLIN WENDY HALE RCP/RRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALE
Provider First Name:
MYLIN
Provider Middle Name:
WENDY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RCP/RRT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESGUERRA
Provider Other First Name:
MYLIN
Provider Other Middle Name:
WENDY LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RCP, RRT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619797230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24539 YORKTOWN HEIGHTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77365-7229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-625-6449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 CYPRESS CREEK PKWY
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:
77090-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-440-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2024

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: 227800000X , with the licence number:  02000836 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2279C0205X , with the licence number: 02000836 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2279C0205X , with the licence number: 160306 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2279G1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 227900000X , with the licence number: 02000836 , 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)