Healthcare Provider Details

I. General information

NPI: 1518218171
Provider Name (Legal Business Name): HEATHER BELINDA GILMORE CST, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 OAK RD APT. 5207
PEARLAND TX
77584-8853
US

IV. Provider business mailing address

2850 OAK RD APT. 5207
PEARLAND TX
77584-8853
US

V. Phone/Fax

Practice location:
  • Phone: 832-475-5720
  • Fax:
Mailing address:
  • Phone: 832-475-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: