Healthcare Provider Details

I. General information

NPI: 1134278476
Provider Name (Legal Business Name): CARLA MAGNOLIA LAOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST STE A.210 TEXAS CHILDREN'S HOSPITAL BCM C/O PEGGY WOMACK
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

2020 MCCLENDON ST UPPER
HOUSTON TX
77030-2118
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-5628
  • Fax: 832-825-5424
Mailing address:
  • Phone: 214-926-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberN1367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: