Healthcare Provider Details

I. General information

NPI: 1346912243
Provider Name (Legal Business Name): YOLANDA MALIWANAG AQUINO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 KATY FWY STE 100
HOUSTON TX
77024-1287
US

IV. Provider business mailing address

31 ROLLINGWOOD DR
HOUSTON TX
77080-7617
US

V. Phone/Fax

Practice location:
  • Phone: 713-984-6720
  • Fax: 713-242-3931
Mailing address:
  • Phone: 832-630-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2033470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: