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General NPI Number Information
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NPI Number | 1114415528
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Entity Type | Organization
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Legal Business Name | TOPS DANIELLE ANDRY, MD, PLLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 4306 YOAKUM BLVD STE 520
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City | HOUSTON
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State | TX
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Zip | 77006
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Country | US
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Telephone | 225-573-0479
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Fax |
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Provider Business Mailing Address
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Address Line | 4306 YOAKUM BLVD STE 520
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City | HOUSTON
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State | TX
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Zip | 77006-5883
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Country | US
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Telephone | 225-573-0479
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DANIELLE ANDRY WIJAY
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Credential | MD
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Telephone | 225-573-0479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | R5693
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License Number State | TX
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