Healthcare Provider Details

I. General information

NPI: 1700984507
Provider Name (Legal Business Name): CHARLOTTE LOUISE MALONE RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

6613 CATHCART DR
HOUSTON TX
77091-1905
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 713-688-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number2471C3401X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: