Healthcare Provider Details

I. General information

NPI: 1932557709
Provider Name (Legal Business Name): DARRELL WESLEY CORNELIUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BERING DR
HOUSTON TX
77057-1457
US

IV. Provider business mailing address

510 BERING DR
HOUSTON TX
77057-1457
US

V. Phone/Fax

Practice location:
  • Phone: 713-569-0245
  • Fax: 405-603-2207
Mailing address:
  • Phone: 713-569-0245
  • Fax: 405-603-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DARRELL CORNELIUS
Title or Position: OWNER
Credential: HIS
Phone: 713-569-0245