Individual
MRS. IVY IVIE COCUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05349
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191332901
—
TX
05
—
191332903 (MDACC)
—
TX
01
—
8393ND
BCBS (MDACC)
TX
01
—
8Y2790
BCBSTX
TX
Enumeration date
01/02/2007
Last updated
06/19/2019
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