=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457360992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENU GARG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 08/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 NORTH LOOP W STE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-1368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-868-0029
-----------------------------------------------------
Fax | 713-880-4706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2636 ALBANS RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-666-7521
-----------------------------------------------------
Fax | 713-880-4706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | G 5078
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------