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NPI Code Detail

MEDICARE: ELISSA LOVE PAC

MEDICARE: ELISSA LOVE PAC
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
1363A00000XPhysician AssistantPA01903TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18242NDOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1275622649
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA LOVE PAC
Provider Business Mailing Address
First Line : 7575 SAN FELIPE ST
Second Line : SUITE 155
City : HOUSTON
State : TX
Zip : 77063-1711
Country : US
Telephone Number : 713-266-9955
Fax Number : 281-266-9956
Provider Business Practice Location Address
First Line : 7575 SAN FELIPE ST
Second Line : SUITE 155
City : HOUSTON
State : TX
Zip : 77063-1711
Country : US
Telephone Number : 713-266-9955
Fax Number : 281-266-9956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 01/06/2014

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Directions to “ ELISSA LOVE PAC” Practice Location

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