Healthcare Provider Details

I. General information

NPI: 1982013199
Provider Name (Legal Business Name): RAUDE YEPEZ CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 FANNIN ST
HOUSTON TX
77054-1938
US

IV. Provider business mailing address

10103 MARISA ALEXIS DR
HOUSTON TX
77075-4693
US

V. Phone/Fax

Practice location:
  • Phone: 713-375-7000
  • Fax: 713-375-7205
Mailing address:
  • Phone: 713-906-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number151336
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: