=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285446955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIUSKA COROMOTO GAMEZ CANIZALEZ CCHI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2025
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3623 HONEY DAISY DR
-----------------------------------------------------
City | CRANDALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75114-0435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-554-3099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3623 HONEY DAISY DR
-----------------------------------------------------
City | CRANDALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75114-0435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-554-3099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171R00000X
-----------------------------------------------------
Taxonomy Name | Interpreter
-----------------------------------------------------
License Number | 013632
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------