Healthcare Provider Details

I. General information

NPI: 1437694684
Provider Name (Legal Business Name): HUONG (MARY) PHAM CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2016
Last Update Date: 12/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10114 BALMANO PL
RICHMOND TX
77407-2833
US

IV. Provider business mailing address

10114 BALMANO PL
RICHMOND TX
77407-2833
US

V. Phone/Fax

Practice location:
  • Phone: 281-989-1302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP238931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: