MEDICARE: IMELDA TJIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	K7222	TX

General Provider Information

NPI Number	:	1215934427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMELDA TJIA

Provider Business Mailing Address
First Line	:	2 E GREENWAY PLZ
Second Line	:	SUITE 900
City	:	HOUSTON
State	:	TX
Zip	:	77046-0297
Country	:	US
Telephone Number	:	713-798-1750
Fax Number	:	713-798-1187

Provider Business Practice Location Address
First Line	:	6621 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2303
Country	:	US
Telephone Number	:	832-824-5800
Fax Number	:	832-825-5801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/17/2009

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Directions to “ IMELDA TJIA ” Practice Location

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