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General NPI Number Information
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NPI Number | 1326235359
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Entity Type | Individual
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Provider Name | LOUISEA MARIE RAYMUN BONOAN DEOMAMPO M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF TEXAS MEDICAL BRANCH- RADIOLOGY 301 UNIVERSITY BOULEVARD ROUTE 0709
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City | GALVESTON
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State | TX
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Zip | 77555-0709
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Country | US
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Telephone | 409-772-2496
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Fax | 409-747-2825
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF TEXAS MEDICAL BRANCH- RADIOLOGY 301 UNIVERSITY BOULEVARD ROUTE 0709
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City | GALVESTON
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State | TX
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Zip | 77555-0709
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Country | US
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Telephone | 409-772-2496
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Fax | 409-747-2825
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | TP10026846
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License Number State | TX
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