Healthcare Provider Details

I. General information

NPI: 1447869714
Provider Name (Legal Business Name): CDVA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 VISTA RD STE 109
PASADENA TX
77504-2117
US

IV. Provider business mailing address

4301 VISTA RD STE 109
PASADENA TX
77504-2117
US

V. Phone/Fax

Practice location:
  • Phone: 832-781-0000
  • Fax: 832-781-1000
Mailing address:
  • Phone: 832-781-0000
  • Fax: 832-384-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANEL MONROE
Title or Position: COO
Credential:
Phone: 832-317-9249