=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154653020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ILEANA Y. TSAI P.A.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2010
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4126 SOUTHWEST FWY. STE. 400
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-479-1100
-----------------------------------------------------
Fax | 713-629-6032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 272629
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77277-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-479-1100
-----------------------------------------------------
Fax | 713-629-6032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA01980
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------