Healthcare Provider Details

I. General information

NPI: 1639493745
Provider Name (Legal Business Name): KRISCHELE M DELACERDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 LEDBETTER ST
HOUSTON TX
77087-5021
US

IV. Provider business mailing address

5931 LEDBETTER ST
HOUSTON TX
77087-5021
US

V. Phone/Fax

Practice location:
  • Phone: 409-256-5677
  • Fax:
Mailing address:
  • Phone: 409-256-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: