Healthcare Provider Details

I. General information

NPI: 1881066421
Provider Name (Legal Business Name): AISHA ODELL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 12/16/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W 20TH ST STE 302
HOUSTON TX
77008-2429
US

IV. Provider business mailing address

427 W 20TH ST STE 302
HOUSTON TX
77008-2429
US

V. Phone/Fax

Practice location:
  • Phone: 713-802-1300
  • Fax:
Mailing address:
  • Phone: 713-802-1300
  • Fax: 713-802-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: