Healthcare Provider Details

I. General information

NPI: 1558748368
Provider Name (Legal Business Name): DENVER NILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/22/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1873
  • Fax:
Mailing address:
  • Phone: 602-933-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberR6856
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberR6856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: