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NPI Code Detail

MEDICARE: DR. BISTRA GUEORGUIEVA VLASSAKOVA M.D.

MEDICARE: DR. BISTRA GUEORGUIEVA VLASSAKOVA M.D.
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
1207LP3000XPediatric Anesthesiology PhysicianW2798TX

General Provider Information

NPI Number : 1790812428
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BISTRA GUEORGUIEVA VLASSAKOVA M.D.
Provider Business Mailing Address
First Line : 6431 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-1501
Country : US
Telephone Number : 937-500-6201
Fax Number :
Provider Business Practice Location Address
First Line : 6411 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-1501
Country : US
Telephone Number : 713-500-6201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 01/13/2026

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