Individual
REGINE MARIE FORTUNOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6701 FANNIN ST, HOUSTON, TX 77030-2608
(832) 824-1000
Mailing address
2 GREENWAY PLZ STE 300, HOUSTON, TX 77046-0207
(832) 828-3660
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
86-0256641
AZ
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
N6299
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36625
AZ MEDICAL LICENSE
AZ
01
—
605-6530
NEONATAL RESUSITATIO
AZ
01
—
N6299
TEXAS LICENSE
TX
Enumeration date
03/07/2007
Last updated
06/10/2014
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