Individual
ALICE CIVITELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA - C
Contact information
Practice address
6620 MAIN ST, STE 1225, HOUSTON, TX 77030-2348
(713) 798-2545
(713) 798-2578
Mailing address
1 BAYLOR PLZ, HOUSTON, TX 77030-3411
(713) 798-4951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00385
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00385
TEXAS MEDICAL LICENSE
TX
Enumeration date
10/21/2014
Last updated
10/21/2014
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