Individual
JITA DE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7205 ALMEDA RD # 30246, HOUSTON, TX 77054-2191
(713) 480-3159
Mailing address
2973 HARBOR BLVD # 148, COSTA MESA, CA 92626-3912
(713) 480-3159
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
042-0015106
VT
207ZH0000X
Hematology (Pathology) Physician
0101249886
VA
207ZH0000X
Hematology (Pathology) Physician
042-0015106
VT
207ZH0000X
Hematology (Pathology) Physician
4301089334
MI
207ZH0000X
Hematology (Pathology) Physician
47658
TN
207ZH0000X
Hematology (Pathology) Physician
Primary
A110924
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
M9957
CA
282N00000X
General Acute Care Hospital
M9957
TX
Other
Enumeration date
09/15/2008
Last updated
03/22/2023
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