Healthcare Provider Details

I. General information

NPI: 1083862718
Provider Name (Legal Business Name): TARINA MICHELE BURDETTE RCP, RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 MAIN ST # 1402
HOUSTON TX
77025-5658
US

IV. Provider business mailing address

11315 MAIN ST # 1402
HOUSTON TX
77025-5658
US

V. Phone/Fax

Practice location:
  • Phone: 713-408-4794
  • Fax:
Mailing address:
  • Phone: 713-408-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number84858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: