Individual
MS. MALLORY CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2626 S LOOP W STE 265, HOUSTON, TX 77054-5636
(713) 796-9955
(281) 754-4524
Mailing address
2626 S LOOP W STE 265, HOUSTON, TX 77054-5636
(713) 796-9955
(281) 754-4524
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA08671
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333252001
—
TX
Enumeration date
10/30/2013
Last updated
08/09/2023
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