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General NPI Number Information
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NPI Number | 1225464860
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Entity Type | Individual
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Provider Name | GAYANA GRIGORYAN ROLAND D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2013
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 21898 FM 1314 RD # B
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City | PORTER
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State | TX
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Zip | 77365-7061
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Country | US
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Telephone | 281-354-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 4949 W DAVIS ST APT 8303
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City | CONROE
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State | TX
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Zip | 77304-5334
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Country | US
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Telephone | 913-579-4616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R5561
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MB10012400
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License Number State | NJ
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