MEDICARE: MITZI STOREY CST

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	246ZS0410X	Surgical Technologist	93703	TX

General Provider Information

NPI Number	:	1871596577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITZI STOREY CST

Provider Business Mailing Address
First Line	:	3333 BAYSHORE BLVD
Second Line	:	STE 200
City	:	PASADENA
State	:	TX
Zip	:	77504-1944
Country	:	US
Telephone Number	:	713-944-5550
Fax Number	:	713-944-5618

Provider Business Practice Location Address
First Line	:	3333 BAYSHORE BLVD
Second Line	:	STE 200
City	:	PASADENA
State	:	TX
Zip	:	77504-1944
Country	:	US
Telephone Number	:	713-944-5550
Fax Number	:	713-944-5618

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/30/2010

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Directions to “ MITZI STOREY CST” Practice Location

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