Healthcare Provider Details

I. General information

NPI: 1962689091
Provider Name (Legal Business Name): ANGELINA FARELLA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HENRIETTA
WEBSTER TX
77598
US

IV. Provider business mailing address

425 HENRIETTA
WEBSTER TX
77598
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-0500
  • Fax: 281-332-0049
Mailing address:
  • Phone: 281-332-0500
  • Fax: 281-332-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK7016
License Number StateTX

VIII. Authorized Official

Name: ANGELINA FARELLA
Title or Position: OWNER
Credential: MD
Phone: 281-332-0500