Healthcare Provider Details

I. General information

NPI: 1215132287
Provider Name (Legal Business Name): MARK FRANGULLIE CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6185 ANDOVER HILLS CT
LEAGUE CITY TX
77573
US

IV. Provider business mailing address

6185 ANDOVER HILLS CT
LEAGUE CITY TX
77573
US

V. Phone/Fax

Practice location:
  • Phone: 713-865-0730
  • Fax:
Mailing address:
  • Phone: 713-865-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License NumberCNIM400
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: