Healthcare Provider Details

I. General information

NPI: 1417735887
Provider Name (Legal Business Name): MARY CATHERINE PACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY C JUREWICZ

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

602 QUINTANA ROO PL
SEABROOK TX
77586-2572
US

V. Phone/Fax

Practice location:
  • Phone: 832-227-1000
  • Fax:
Mailing address:
  • Phone: 328-315-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPENDING
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: