1356937247 NPI number — HASEL TANIA ISLAS-GONZALEZ SLP-A

Table of content: HASEL TANIA ISLAS-GONZALEZ SLP-A (NPI 1356937247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356937247 NPI number — HASEL TANIA ISLAS-GONZALEZ SLP-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISLAS-GONZALEZ
Provider First Name:
HASEL
Provider Middle Name:
TANIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356937247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
872 BETTINA CT APT 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-269-1949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21630 MERCHANTS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77449-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-230-1518
Provider Business Practice Location Address Fax Number:
281-741-7355
Provider Enumeration Date:
12/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  41713 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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