Healthcare Provider Details

I. General information

NPI: 1912191453
Provider Name (Legal Business Name): NATHALIE K. ROFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATHALIE K ROFF M.D.

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST STE 657
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

25 1/2 COURTLANDT PL
HOUSTON TX
77006-4013
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-2235
  • Fax: 346-238-0122
Mailing address:
  • Phone: 713-522-1240
  • Fax: 832-218-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberJ9546
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberJ9546
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ9546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: