Healthcare Provider Details

I. General information

NPI: 1902446636
Provider Name (Legal Business Name): DHIEGO CHAVES DE ALMEIDA BASTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOLCOMBE BLVD
HOUSTON TX
77030-4008
US

IV. Provider business mailing address

7171 BUFFALO SPEEDWAY APT 2823
HOUSTON TX
77025-1440
US

V. Phone/Fax

Practice location:
  • Phone: 713-563-8712
  • Fax:
Mailing address:
  • Phone: 832-933-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.143328
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: