1790779668 NPI number — DR. DENISE SLANICKY MASTERSON AUD

Table of content: DR. DENISE SLANICKY MASTERSON AUD (NPI 1790779668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790779668 NPI number — DR. DENISE SLANICKY MASTERSON AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASTERSON
Provider First Name:
DENISE
Provider Middle Name:
SLANICKY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLANICKY
Provider Other First Name:
DENISE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790779668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST
Provider Second Line Business Mailing Address:
STE 2001
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-796-2001
Provider Business Mailing Address Fax Number:
713-796-2349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 FANNIN 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:
77030-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-796-2001
Provider Business Practice Location Address Fax Number:
713-796-2349
Provider Enumeration Date:
09/07/2005

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: 231H00000X , with the licence number:  51086 , 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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