=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205299450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLANDO TERNENY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2016
-----------------------------------------------------
Last Update Date | 04/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5959 WESTHEIMER RD STE 132
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-7622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-588-1425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5959 WESTHEIMER RD STE 132
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-7622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-588-1425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AGENT
-----------------------------------------------------
Name | TAMARA RISPOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-255-3415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | D7896
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------