Individual
IMELDA ALTJI PANGEMANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP-BC
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
721130
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP120706
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01609023
AMERIGROUP
TX
05
—
286527101
—
TX
05
—
286527102
—
TX
01
—
859N14
BCBS
TX
01
—
P01025636
RAILROAD MEDICARE
TX
Enumeration date
08/23/2011
Last updated
12/14/2014
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