Healthcare Provider Details

I. General information

NPI: 1881012573
Provider Name (Legal Business Name): ALICIA TARAVELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 FROSTWOOD DR
HOUSTON TX
77024-4131
US

IV. Provider business mailing address

833 FROSTWOOD DR
HOUSTON TX
77024-4131
US

V. Phone/Fax

Practice location:
  • Phone: 713-468-2330
  • Fax: 832-358-9301
Mailing address:
  • Phone: 713-468-2330
  • Fax: 832-358-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: