Healthcare Provider Details

I. General information

NPI: 1043731748
Provider Name (Legal Business Name): BREANA LYNN UZETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

V. Phone/Fax

Practice location:
  • Phone: 347-707-2691
  • Fax:
Mailing address:
  • Phone: 347-707-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10060938
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS5797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: