Individual
TIESSA LURAE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
927 STRAWBERRY RD, PASADENA, TX 77506-4821
(346) 308-0720
Mailing address
927 STRAWBERRY RD, PASADENA, TX 77506-4821
(346) 308-0720
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
00103103
TX
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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