Individual
EVANGELINE PENANO TOMONGHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 840853, DALLAS, TX 75284-0865
(972) 715-5000
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP124288
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324143201
—
TX
05
—
324143203
—
TX
01
—
8240UF
BCBS
TX
01
—
P01748434
RR MEDICARE
TX
Enumeration date
08/29/2013
Last updated
07/14/2020
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